200000 BLOOD FORMULATION, COAGULATION AND THROMBOSIS 201200 ANTITHROMBOTIC AGENTS 201204 ANTICOAGULANTS 20120414 DIRECT FACTOR XA INHIBITORS
Date Listed/Coverage Update:	01-Feb-2023
Unit Price:	1.6337
LCA Price:	0.4084
MAC Price:	N/A
Unit of Issue:	Tablet
Manufacturer:	BRISTOL-MYERS SQUIBB (BMS)
ATC:	B01AF02
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 2022/11/17 2023/02/01 Change to Regular Benefit THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Common Drug Review 2014/10/02 2015/09/01 Under Review THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Common Drug Review 2014/10/02 2015/10/01 Special Authorization Criteria Change THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Common Drug Review 2014/10/02 2015/05/07 View CDR - List with clinical criteria and/or conditions THROMBOEMBOLIC EVENTS, PREVENTION (ATRIAL FIBRILLATION) Common Drug Review 2012/10/10 2013/03/20 View CDR - List with criteria/condition Please select one Change to Regular Benefit Under Review Special Authorization Criteria Change CDR - List with clinical criteria and/or conditions CDR - List with criteria/condition Indication N/A Reviewing Body Expert Committee Submission Completion Date 2022/11/17 CDR Recommendation Date Expert Committee Recommendation Date ADBL Effective Date 2023/02/01 CDR Recommendation Review Status Change to Regular Benefit Indication THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Reviewing Body Common Drug Review Submission Completion Date 2014/10/02 CDR Recommendation Date Expert Committee Recommendation Date ADBL Effective Date 2015/09/01 CDR Recommendation Review Status Under Review Indication THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Reviewing Body Common Drug Review Submission Completion Date 2014/10/02 CDR Recommendation Date Expert Committee Recommendation Date ADBL Effective Date 2015/10/01 CDR Recommendation Review Status Special Authorization Criteria Change Indication THROMBOEMBOLIC EVENTS (VENOUS), TREATMENT & PREVENTION OF RECURRENCE Reviewing Body Common Drug Review Submission Completion Date 2014/10/02 CDR Recommendation Date 2015/05/07 Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation View Review Status CDR - List with clinical criteria and/or conditions Indication THROMBOEMBOLIC EVENTS, PREVENTION (ATRIAL FIBRILLATION) Reviewing Body Common Drug Review Submission Completion Date 2012/10/10 CDR Recommendation Date 2013/03/20 Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation View Review Status CDR - List with criteria/condition