Apixaban 5 MG Tablet UD (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.**
Alogliptin (Nesina™)
Apremilast (Otezla™, Celgene™)
Amantadine (Symmetrel™)
Aripiprazole IM Syringe 675 MG/2.4ML (Astrada Initio)
Aripiprazole is now a Non-formulary item as of 09/27/2010 , No new scripts may be written without a non-formulary request approval, all existing scripts must be tapered off
per protocol and/or switched to a formulary agent prior to 3/26/2011 ****
**MLP Requires Cosign**