Anticoagulants, Oral and SQ
PDL Reference Documents
- Anticoagulants - Feb 04, 2021
- Anticoagulants - Nov 21, 2019
- Anticoagulants Literature Scan - May 25, 2017
- Direct-acting Anticoagulants - Jul 28, 2016
- Anticoagulants - May 28, 2015
- Anticoagulant Class Update - Jul 31, 2014
- Abbreviated Class Update: Anticoagulants - Mar 28, 2013
- Class Review: Oral Anticoagulants - Jan 26, 2012
Drug Use Review Documents
Newsletters
- November 2017 - Marketing Claims of Newer Drugs and the Evidence
- August 2017 - Oral Anticoagulant Update
- October 2015 - From Antidotes to Edoxaban: An Oral Anticoagulation Update
- October 2014 - What's New with Oral Anticoagulants?
- November 2013 - Update on the New Oral Anticoagulants with a Focus on Apixaban
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation |
---|---|---|---|---|---|
apixaban | ELIQUIS | TAB DS PK | Y | ||
apixaban | ELIQUIS | TABLET | Y | ||
dabigatran etexilate mesylate | PRADAXA | CAPSULE | Y | Jan 26, 2012 | |
dabigatran etexilate mesylate | DABIGATRAN ETEXILATE | CAPSULE | Y | ||
edoxaban tosylate | SAVAYSA | TABLET | Y | ||
enoxaparin sodium | LOVENOX | SYRINGE | Y | ||
enoxaparin sodium | ENOXAPARIN SODIUM | SYRINGE | Y | ||
enoxaparin sodium | LOVENOX | VIAL | Y | ||
enoxaparin sodium | ENOXAPARIN SODIUM | VIAL | Y | ||
rivaroxaban | XARELTO | TAB DS PK | Y | ||
rivaroxaban | XARELTO | TABLET | Y | Jan 26, 2012 | |
warfarin sodium | WARFARIN SODIUM | TABLET | Y | ||
warfarin sodium | JANTOVEN | TABLET | Y | ||
dabigatran etexilate mesylate | PRADAXA | PELET PACK | N | ||
dalteparin sodium,porcine | FRAGMIN | SYRINGE | N | ||
dalteparin sodium,porcine | FRAGMIN | VIAL | N | ||
enoxaparin sodium | LOVENOX | AMPUL | N | ||
fondaparinux sodium | ARIXTRA | SYRINGE | N | ||
fondaparinux sodium | FONDAPARINUX SODIUM | SYRINGE | N | ||
rivaroxaban | XARELTO | SUSP RECON | N |