Limited coverage drugs – tinzaparin

Last updated on September 27, 2024

Generic name

tinzaparin

Brand name

Dosage form

Strength

Innohep®

prefilled 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

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

OR

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)

OR

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 VTE prevention in patients:

 

  • following elective total knee replacement surgery OR
  • up to 14 days
  • following elective total hip replacement surgery OR
  • up to 35 days
  • following orthopedic surgery for major trauma OR
  • up to 10 days
  • with lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia OR
  • 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).

Special Authority requests