Anticoagulation prescription details and prescription assistance programs

PULMONARY EMBOLISM

Anticoagulant Prescription Details

Single-Drug Therapy Options for Acute Pulmonary Embolism

ApixabanRivaroxaban
Apixaban 5 mg tablets “Starter Pack”Rivaroxaban “Starter Pack”
Sig: two tablets (10 mg) PO BID for 7 days, then one tablet (5 mg) PO BID thereafter

 

Sig: Take as directed by starter pack

Starter pack provides a 30 day supply:

-15 mg PO BID with food (42 tablets) for the first 21 days

-20 mg PO daily with food (9 tablets) for days 22-30

Dispense 74 tablets for the first 30 daysDispense 30 tablets of 20 mg each subsequent months (at least 2 more months)
Dispense 60 tablets each subsequent month (at least 2 more months)If starter pack is unavailable:
Write for Rivaroxaban as indicated above

Prescription Assistance

Apixaban (bmspaf.org and eliquis.bmscustomerconnect.com)

  • Non-Medicare Part D patients with low income
  • Copay Card for non-government insurance
  • 30-day trail for all patients

Riaroxaban (www.janssenprescriptionassistance.com)

  • Co-pay assistance  (for non-Medicare/non-Medicaid)
  • 30-day trial card for all patients
  • Johnson & Johnson Patient Assistance Foundation
  • State-sponsored Programs
  • Medicare Part D Low-Income Subsidy

Two-Drug Therapy Options for Acute Pulmonary Embolism

LMWH (Enoxaparin)FondaparinuxWarfarinDabigatranEdoxaban
LMWH 1.0 mg/kg dosing subcutaneously twice daily or 1.5 mg/kg every 24 hours

Starter therapy for all two-drug options

LMWH 1 mg/kg dosing subcutaneously daily if CrCl < 30 mL/min

Do not use if patient is on hemodialysis

 

Fondaparinux dosing is 5 mg for patients weighing < 50 kg, 7.5 mg for patients weighing >50 to <100 kg and 10 mg for patients weighing > 100 kg subcutaneously once daily)

Do not use if CrCl is < 30 ml/min

Do not use if pregnant

Do not use if patient is on hemodialysis

Warfarin 5 mg daily – start on day 1

Overlap with a parenteral anticoagulant a minimum of 5 days and until the INR is > 2 for 24 hours

Do not use if pregnant

Supply enough for at least 3 months

Dabigatran 150 mg tablet twice daily starting after 5 – 10 days of heparin, LMWH or Fondaparinux.

Dispense 60 tablets per month (at least 3 months)

Do not use if Cr Cl < 30 mL/min

 

Edoxaban 60 mg tablets daily starting 5-10  days of heparin, LMWH or Fondaparinux

Dispense 30 tablets per month (at least 3 months)

Reduce edoxaban dose to 30 mg daily if CrCl , 15 to 50 ml/min or weight ≤60 kg or use of strong P-gp inhibitor

Dabigatran (pradaxa.com/savings)

  • Commercial insurance may save up to $2400 over one year
  • 30-day trial for all patients

Edoxaban (savaysa.com/support-plus-program.html)

  • $4 for 30 days, of $12 for 90 days of medication
  • Not valid for Medicare Part D and Medicaid patients

References: FDA prescribing information (fda.gov)