Eliquis (apixaban tablets) — Cigna
Treatment or Prevention of Other Thromboembolic-Related Conditions
Initial criteria
- Patient weight ≥ 35 kg
- AND Patient meets ONE of the following:
- Patient has tried warfarin, fondaparinux injection, or a low molecular weight heparin product (e.g., enoxaparin injection, Fragmin [dalteparin injection])
- OR Patient has been started on Eliquis for the treatment of an acute thromboembolic condition
Approval duration
6 months