Limited coverage drugs – dalteparin
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Generic name |
dalteparin |
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Brand name |
Dosage form |
Strength |
Fragmin® |
prefilled syringe (PFS) |
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blister |
10,000 IU/mL |
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vial |
25,000 IU/mL |
Treatment of venous thromboembolism
Special Authority criteria |
Approval period |
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For the treatment of: |
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Prophylaxis of venous thromboembolism
Special Authority Criteria |
Approval Period |
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For prevention in patients: |
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Practitioner exemptions
- PharmaCare coverage will be provided for a patient who meets the Limited Coverage criteria, and whose prescription is written by an orthopedic surgeon who has entered into a Collaborative Prescribing Agreement (PDF, 291KB)
- Due to the individual nature of each Collaborative Prescribing Agreement, the agreement must be signed by the prescriber and not their delegate
Special notes
- The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital) setting. The approval period is for the balance of the total duration after discharge (i.e., for outpatients only)