Limited Use Note(s) |
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ENOXAPARIN150mg/mL Pref Syr-1mL Pk
Reason For Use Code | Clinical Criteria |
---|---|
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 |