aspirin extended-release capsules (Durlaza®)

ORAL

Indications for Prior Authorization:

  • To reduce the risk of death and MI in patients with CAD and to reduce the risk of death and recurrent stroke in patients who have had an ischemic stroke or TIA 

All of the following must be met as a condition for coverage:

  • Use is reduce the risk of death and MI in patients with CAD and to reduce the risk of death and recurrent stroke in patients who have had an ischemic stroke or TIA 
  • Patient has tried/failed all other available aspirin formulations as supported by chart note documentation provided

This Medication is Not Approvable for the following condition(s):

  • Any condition not listed above as an approved indication

Dosing:

  • 162 mg per day with a full glass of water the same time each day

Approval duration

One year


 

Last review date: July 24, 2016

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