anamivir (Relenza™)
Adalimumab (Humira™ )
Apixaban (Eliquis™ )
Albiglutide (Tanzeum™)
Apixaban 2.5 MG Tablet (Eliquis)
Non-Formulary Use Criteria: **1. Patients being treated for atrial fibrillation with an INR that is unable to be stabilized on Warfarin therapy despite being enrolled into an anticoagulation clinic.**
**2. Patients previously stabilized on a direct thrombin inhibitor or Factor Xa inhibitor with an appropriate diagnosis. NOTE: NFR for new intakes may be approved for 90 days at
care level 1 and 2 institutions and for 30 days at care level 3 and 4 institutions pending appropriate assessment and conversion to Warfarin.**
**3. The expectation is that patients will be converted to Warfarin within the time frames listed in the non-formulary use criteria.**
Alfuzosin (Uroxatral™)
Apixaban 2.5 MG Tablet UD (Eliquis) Tab
Non-Formulary Use Criteria: **1. Patients being treated for atrial fibrillation with an INR that is unable to be stabilized on Warfarin therapy despite being enrolled into an anticoagulation clinic.**
**2. Patients previously stabilized on a direct thrombin inhibitor or Factor Xa inhibitor with an appropriate diagnosis. NOTE: NFR for new intakes may be approved for 90 days at
care level 1 and 2 institutions and for 30 days at care level 3 and 4 institutions pending appropriate assessment and conversion to Warfarin.**
**3. The expectation is that patients will be converted to Warfarin within the time frames listed in the non-formulary use criteria.**
Alirocumab (Praluent™)
Apixaban 5 MG Tablet (Eliquis) Tab
Non-Formulary Use Criteria: **1. Patients being treated for atrial fibrillation with an INR that is unable to be stabilized on Warfarin therapy despite being enrolled into an anticoagulation clinic.**
**2. Patients previously stabilized on a direct thrombin inhibitor or Factor Xa inhibitor with an appropriate diagnosis. NOTE: NFR for new intakes may be approved for 90 days at
care level 1 and 2 institutions and for 30 days at care level 3 and 4 institutions pending appropriate assessment and conversion to Warfarin.**
**3. The expectation is that patients will be converted to Warfarin within the time frames listed in the non-formulary use criteria.**