Limited Use Note(s)

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ENOXAPARIN120mg/0.8mL Pref Syr-0.8mL Pk
Reason For Use CodeClinical Criteria
678For 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
679For 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