ELIQUIS (apixaban)

SELF ADMINISTRATION - ORAL

Indication for Prior Authorization:
  • Reduce the risk of stroke and systematic embolism in nonvalvular atrial fibrillation.
  • Prophylaxis of deep vein thrombosis (DVT) following hip or knee replacement surgery.
  • Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • Reduction in the risk of recurrent DVT and PE following initial therapy.
Coverage Criteria:

For diagnosis of nonvalvular atrial fibrillation (Afib):

  • Diagnosis of nonvalvular Afib.

The drug is being used to treat a diagnosis as approved by the Food and Drug Administration (FDA):

  • Prophylaxis of DVT following hip or knee replacement surgery.
  • Treatment of DVT or PE.
  • Reduction in the risk of recurrent DVT or PE following initial therapy.
     
Dosing:

For diagnosis of nonvalvular atrial fibrillation:

  • 5 mg twice daily
  • 2.5 mg twice daily if two of the following:
    • Age 80 years or older
    • Body weight less than or equal to 60 kg
    • Serum creatinine greater than or equal to 1.5 mg/dL

For diagnosis of DVT prophylaxis following hip or knee replacement surgery:

  • 2.5 mg twice daily
    • Recommended duration is 35 days after hip replacement surgery.
    • Recommended duration is 12 days after knee replacement surgery.
    • Initial dose should be taken 12 to 24 hours after surgery.

For diagnosis of DVT/PE:

  • 10 mg twice daily for the first 7 days followed by 5 mg twice daily.

For diagnosis of risk recurrence of DVT/PE:

  • 2.5 mg twice daily after at least 6 months of treatment for DVT or PE.
     
Coverage Duration:

1 year.

Authorization is Not Covered for the Following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

Additional Information:
  • Premature discontinuation of any oral anticoagulant, including ELIQUIS, increases the risk of thrombotic events.
  • Epidural or spinal hematomas may occur in patients treated with ELIQUIS who are receiving neuraxial anesthesia or undergoing spinal puncture.
  • ANDEXXA® (coagulation factor Xa [recombinant], inactivated-zhzo) is an FDA-approved antidote for apixaban in patients with life-threatening or uncontrolled bleeding.
Review History:
  • 12/30/2020 – Annual policy review; format updated; most recent FDA approved indications listed on policy.
  • 12/02/2013 – New policy for Afib approved by WHA P&T.
References:
  • Eliquis [package insert]. Princeton (NJ): Bristol-Myers Squibb Company; 2012.

 


 

Last review date: December 30, 2020