Xarelto (rivaroxaban tablets [generic for 2.5 mg tablet strength only] and oral suspension [generic]) — Cigna
Deep Vein Thrombosis or Pulmonary Embolism, Treatment
Initial criteria
- Xarelto tablets: Approve
- Rivaroxaban oral suspension (brand or generic product): Approve if patient is unable to have Xarelto tablets appropriately administered OR the prescribed dose cannot be achieved by Xarelto 10 mg, 15 mg, or 20 mg tablets
Approval duration
1 year