Limited Use Note(s) |
|
RIVAROXABAN10mg Tab
| Reason For Use Code | Clinical Criteria |
|---|---|
| 433 | For the prevention of venous thromboembolic events in patients who have undergone elective total knee replacement (TKR) surgery. Note: Limited to 14 days of reimbursement in TKR. Limited to 1 claim in a 120 day period. |
| LU Authorization Period: 1 year | |
| 434 | For the prevention of venous thromboembolic events in patients who have undergone elective total hip replacement (THR). Note: Limited to 35 days of reimbursement in THR. Limited to 1 claim in a 120 day period. |
| LU Authorization Period: 1 year |