Interactive Drug Benefit List
Date Listed/Coverage Update:
01-Mar-2024
Unit Price:
2.8700
LCA Price:
0.7175
MAC Price:
N/A
Unit of Issue:
Tablet
Manufacturer:
BAYER INC. (BAI)
ATC:
B01AF01
Provincial Drug Schedule:
1
Interchangeable Products:
Yes
Coverage Status:
REGULAR BENEFIT
Applies to Clients of:
Non-Group Coverage (Group 1) Coverage for Seniors (Group 66) Palliative Coverage (Group 20514, Please note your client may have Group 1 or Group 66 coverage) Child and Family Services (Group 20403) Alberta Child Health Benefit (Group 20400) Children and Youth Services (Group 19824) Income Support (Group 19823) Alberta Human Services (AISH) (Group 19823) Alberta Adult Health Benefit (AAHB) (Group 23609)
Special Authorization Request Form:
N/A
Coverage Criteria:
N/A
Review Status / Past Decisions
Indication
Reviewing Body
Submission Completion Date
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
Review Status
N/A
Expert Committee
2024/01/16
2024/03/01
Change to Regular Benefit
PULMONARY EMBOLISM
Expert Committee
2015/03/12
2015/05/01
No Special Authorization Criteria Change
PULMONARY EMBOLISM
Expert Committee
2015/03/12
2016/01/01
Special Authorization Criteria Change
PULMONARY EMBOLISM
Common Drug Review
2013/05/13
2014/07/01
Under Review
PULMONARY EMBOLISM
Common Drug Review
2013/05/13
2015/03/01
Special Authorization Criteria Change - Venous Thrombolic Events
PULMONARY EMBOLISM
Common Drug Review
2013/05/13
2014/03/26
View
CDR - List with clinical criteria and/or conditions
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Common Drug Review
2013/04/09
2013/07/18
View
CDR - List with criteria/condition
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/10/24
2013/09/01
Special Authorization - DVT Treatment without Symptomatic PE
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/03/05
2013/06/01
Under Review
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/03/05
2012/08/16
View
CDR - List with criteria/condition
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/03/05
2013/02/01
Under Review
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/03/05
2012/11/01
Under Review
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Common Drug Review
2012/03/05
2013/03/01
Under Review
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Common Drug Review
2011/11/04
2012/10/01
Step Therapy/Special Authorization - AF/Stroke Prevention
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Common Drug Review
2011/11/04
2012/04/19
View
CDR - List with criteria/condition
Please select one
Change to Regular Benefit
No Special Authorization Criteria Change
Special Authorization Criteria Change
Under Review
Special Authorization Criteria Change - Venous Thrombolic Events
CDR - List with clinical criteria and/or conditions
CDR - List with criteria/condition
Special Authorization - DVT Treatment without Symptomatic PE
Under Review
CDR - List with criteria/condition
Under Review
Under Review
Under Review
Step Therapy/Special Authorization - AF/Stroke Prevention
CDR - List with criteria/condition
Indication
N/A
Reviewing Body
Expert Committee
Submission Completion Date
2024/01/16
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2024/03/01
CDR Recommendation
Review Status
Change to Regular Benefit
Indication
PULMONARY EMBOLISM
Reviewing Body
Expert Committee
Submission Completion Date
2015/03/12
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2015/05/01
CDR Recommendation
Review Status
No Special Authorization Criteria Change
Indication
PULMONARY EMBOLISM
Reviewing Body
Expert Committee
Submission Completion Date
2015/03/12
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2016/01/01
CDR Recommendation
Review Status
Special Authorization Criteria Change
Indication
PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2013/05/13
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2014/07/01
CDR Recommendation
Review Status
Under Review
Indication
PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2013/05/13
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2015/03/01
CDR Recommendation
Review Status
Special Authorization Criteria Change - Venous Thrombolic Events
Indication
PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2013/05/13
CDR Recommendation Date
2014/03/26
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
View
Review Status
CDR - List with clinical criteria and/or conditions
Indication
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Reviewing Body
Common Drug Review
Submission Completion Date
2013/04/09
CDR Recommendation Date
2013/07/18
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
View
Review Status
CDR - List with criteria/condition
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/10/24
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2013/09/01
CDR Recommendation
Review Status
Special Authorization - DVT Treatment without Symptomatic PE
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/03/05
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2013/06/01
CDR Recommendation
Review Status
Under Review
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/03/05
CDR Recommendation Date
2012/08/16
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
View
Review Status
CDR - List with criteria/condition
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/03/05
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2013/02/01
CDR Recommendation
Review Status
Under Review
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/03/05
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2012/11/01
CDR Recommendation
Review Status
Under Review
Indication
DVT (TREATMENT), WITHOUT SYMPTOMATIC PULMONARY EMBOLISM
Reviewing Body
Common Drug Review
Submission Completion Date
2012/03/05
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2013/03/01
CDR Recommendation
Review Status
Under Review
Indication
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Reviewing Body
Common Drug Review
Submission Completion Date
2011/11/04
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2012/10/01
CDR Recommendation
Review Status
Step Therapy/Special Authorization - AF/Stroke Prevention
Indication
PREVENTION OF STROKE IN PATIENTS WITH A. FIB.
Reviewing Body
Common Drug Review
Submission Completion Date
2011/11/04
CDR Recommendation Date
2012/04/19
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
View
Review Status
CDR - List with criteria/condition
GLOSSARY
Telephone:
(905) 282-5550
Toll-Free:
(800) 622-2937
To return to the printable Drug Benefit List and related publications,
click here
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL) , and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.