Pradaxa Oral Pellets — Medical Mutual
Venous Thromboembolic Events, Treatment
Initial criteria
- Patient is age ≥ 3 months to < 12 years
- Patient has had a trial of Eliquis or Xarelto OR Patient is currently receiving Pradaxa oral pellets
Reauthorization criteria
- Continuation requires response to therapy unless otherwise noted
Approval duration
1 year