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Limited coverage criteria – tinzaparin

Last updated on March 24, 2025

 

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Generic name

tinzaparin

Brand name

Dosage form

Strength

Innohep®

pre-filled syringe
  • 2,500 IU/0.25 mL
  • 3,500 IU/0.35 mL
  • 4,500 IU/0.45 mL
  • 8,000 IU/0.4 mL
  • 10,000 IU/0.5 mL
  • 12,000 IU/0.6 mL
  • 14,000 IU/0.7 mL
  • 16,000 IU/0.8 mL
  • 18,000 IU/0.9 mL

vial
  • 10,000 IU/mL
  • 20,000 IU/mL

Special Authority criteria
Treatment of venous thromboemolism

Approval period

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 on 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

Special Authority criteria
Prophylaxis of venous thromboemolism

Approval period
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

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
  • The Collaborative Prescribing 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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