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Limited coverage criteria – enoxaparin

Last updated on March 17, 2025

 

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Generic name

enoxaparin

Brand name

Strength

Form

Noromby
  • 20 mg/0.2 mL
  • 30 mg/0.3 mL
  • 40 mg/0.4 mL
  • 60 mg/0.6 mL
  • 80 mg/0.8 mL
  • 100 mg/mL

prefilled syringe (PFS)

Noromby HP
  • 120 mg/0.8 mL
  • 150 mg/mL

PFS

Inclunox
  • 30 mg/0.3 mL
  • 40 mg/0.4 mL
  • 60 mg/0.6 mL
  • 80 mg/0.8 mL
  • 100 mg/mL

PFS

Inclunox HP
  • 120 mg/0.8 mL
  • 150 mg/mL

PFS

Redesca
  • 30 mg/0.3 mL,
  • 40 mg/0.4 mL,
  • 60 mg/0.6 mL,
  • 80 mg/0.8 mL

PFS
  • 100 mg/mL
  • 300 mg/3 mL

vial

Redesca HP
  • 120 mg/0.8 mL
  • 150 mg/mL

PFS

Elonox
  • 30 mg/0.3 mL
  • 40 mg/0.4 mL
  • 60 mg/0.6 mL
  • 80 mg/0.8 mL
  • 100 mg/mL

PFS

Elonox HP
  • 120 mg/0.8 mL
  • 150 mg/mL

PFS

Treatment of venous thromboembolism

Special Authority criteria

Approval period

For the treatment of:

 

Patients with acute deep vein thrombosis or pulmonary embolus who continue to receive care after leaving an acute care (hospital) setting. This treatment bridges the time gap to achieve therapeutic INR on oral anticoagulants

Up to 10 days supply

Patients with treatment failure of oral anticoagulant therapy (recurrence of one or more deep vein thromboses or pulmonary emboli in patients with therapeutic INR on oral anticoagulants)

Up to 3 months, then reassessed

Patients with cancer associated thrombosis

Up to 6 months

Prophylaxis of venous thromboembolism

Special Authority criteria

Approval period

For prevention in patients:

 

Following elective total knee replacement surgery

Up to 14 days

Following elective total hip replacement surgery

Up to 35 days

Following orthopedic surgery for major trauma

Up to 10 days

With lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia

Up to 3 months

Before, during or after pregnancy

Up to 4 weeks post-partum

Following abdominal or pelvic surgery for the management of a malignant tumour (applicable to dalteparin and enoxaparin prescriptions only)

Up to 10 days

Following abdominal or pelvic surgery for the management of a malignant tumour (applicable to dalteparin and enoxaparin prescriptions only) and who are at high risk (defined as those with previous history of VTE and/or anesthesia lasting longer than 2 hours and/or bed rest lasting 4 days or longer following surgery)

Up to 28 days for high-risk patients

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 (CPA) (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)

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