| 186 | For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks; |
| | LU Authorization Period: 1 year |
| 187 | For DVT in pregnant or lactating females; |
| | LU Authorization Period: 1 year |
| 188 | For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated; |
| | LU Authorization Period: 1 year |
| 189 | For DVT in patients who have failed treatment with warfarin. |
| | LU Authorization Period: 1 year |
| 323 | For the acute treatment of pulmonary embolism, maximum of three weeks. |
| | LU Authorization Period: 1 year |
| 678 | For the treatment of pulmonary embolism, deep vein thrombosis who meet the following criteria:
- Patients who become pregnant during the transition period of July 31, 2024, to January 31, 2025. |
| | LU Authorization Period: Up to 12 months |
| 679 | For the treatment of pulmonary embolism, deep vein thrombosis who meet the following criteria:
- Patients who require palliative care during the transition period of July 31, 2024, to January 31, 2025. |
| | LU Authorization Period: Up to 12 months |
