Limited Coverage Drugs – Clopidogrel
Generic Name |
clopidogrel |
---|---|
Strength |
75 mg |
Form |
tablet |
Special Authority Criteria |
Approval Period |
---|---|
To be taken in combination with ASA after revascularization with Percutaneous Coronary Intervention (PCI) | Up to 12 months |
OR | |
To be taken in combination with ASA for high-risk1, medically-treated patients following hospital-diagnosed unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI) | Up to 12 months |
OR | |
To be taken for the secondary prevention of coronary, cerebral and peripheral vascular occlusion and embolization where a person has experienced treatment failure or intolerance to optimal ASA therapy. Notes:
|
Indefinite |
Practitioner Exemptions
- Cardiologists are invited to enter into a Collaborative Prescribing Agreement (CPA) to permit exemption from completing Special Authority requests for clopidogrel when prescribed according to PharmaCare’s coverage criteria. To ensure uninterrupted coverage for patients, cardiologists who sign a CPA must write prescriptions for clopidogrel for the full intended duration of therapy (e.g., up to 12 months).
- Prescriptions written by others who have not entered into a CPA will not be covered automatically.
Special Notes
- A history of arterial disease is defined as previous transient ischemic attack (TIA), stroke or symptomatic peripheral artery disease.
- Clinical judgment is warranted to assess the increased bleeding risk of combining clopidogrel plus ASA and/or oral anticoagulants.