Limited coverage drugs – nadroparin
Special Authority requests can now be submitted online. It's simple and quick!
|Generic Name / Strength / Form|
|Fraxiparine / 2,850 Iu(Anti-Xa)/0.3 mL / SYRINGE|
|Fraxiparine / 3,800 Iu(Anti-Xa)/0.4 mL / SYRINGE|
Fraxiparine / 5,700 Iu(Anti-Xa)/0.6 mL / SYRINGE
|Fraxiparine / 9,500 Iu(Anti-Xa)/0.3 mL / SYRINGE|
|Fraxiparine / 11,400 Iu(Anti-Xa)/0.6 mL / SYRINGE|
|Fraxiparine / 15,200 Iu(Anti-Xa)/0.8 mL / SYRINGE|
|Fraxiparine / 19,000 Iu(Anti-Xa)/1 mL / SYRINGE|
Approval period (to complete the balance of a total duration of therapy for outpatients)
|Treatment of venous thromboembolism|
|1. Treatment of acute deep vein thrombosis or pulmonary embolus continued from an acute care (hospital) setting to bridge time to achieve therapeutic INR on oral anticoagulants.||1. Up to 10 days supply|
|2. Following failure on oral anticoagulant therapy (recurrence of one or more deep vein thromboses or pulmonary emboli in patients with therapeutic INR on oral anticoagulants).||2. Up to 3 months, then reassessed|
|Prophylaxis of venous thromboembolism|
|3. Following elective total knee replacement surgery.||3. Up to 14 days|
|4. Following elective total hip replacement surgery.||4. Up to 35 days|
|5. Following orthopedic surgery for major trauma.||5. Up to 10 days|
|6. Concurrent lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia.||6. Up to 3 months|
|7. Associated with pregnancy.||7. Up to 4 weeks post-partum.|
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.
Due to the individual nature of each Collaborative Prescribing Agreement, the Agreement must be signed by the prescriber and not his/her delegate.
- The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital) setting, and the approval period is for the balance of the total duration after discharge (i.e., for outpatients only).
Special Authority request form(s)
- Log in to eForms
- 5338 - Low Molecular Weight Heparin Form (PDF)
- 5469 - Venous Thromboembolism In Cancer Patients (PDF)