Self administration: Oral
Indications for Prior Authorization
- Approvable to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
Patients must meet the following criteria for the indication(s) above.
Diagnosis of nonvalvular atrial fibrillation
The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee.
- All non-FDA approved uses not listed in the approved indications
- 5mg twice a day
- Age > 80 years, or body weight <60 kg, or serum creatinine > 1.5 mg/dL: 2.5 mg twice a day
Western Health Advantage Pharmacy and Therapeutics Committee
Approved/Revised: March 2013 Reviewed: December 2013