Product Details

Lovenox

Enoxaparin
100 mg/mL
Solution for Injection
3-mL Multidose Vial Pack (with Preservative)

DIN/PIN/NPN

02236564

Manufacturer

Sanofi Aventis Pharma

Formulary Listing Date

2003-01-30

Unit Price

68.7500

Amount MOH Pays

68.7500

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

20:12:00 Coagulants and Anti-Coagulants

Therapeutic Note

NO

ATC Code

B01AB05

Interchangeable Products

NO

LU Clinical Criteria

LU Code	Auth. Period	Clinical Criteria
186	1 year	For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks;
187	1 year	For DVT in pregnant or lactating females;
188	1 year	For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated;
189	1 year	For DVT in patients who have failed treatment with warfarin.
323	1 year	For the acute treatment of pulmonary embolism, maximum of three weeks.
678	1 year	For the treatment of pulmonary embolism, deep vein thrombosis who meet the following criteria: Patients who become pregnant during the transition period of July 31, 2024, to January 31, 2025.
679	1 year	For the treatment of pulmonary embolism, deep vein thrombosis who meet the following criteria: Patients who require palliative care during the transition period of July 31, 2024, to January 31, 2025.

EAP Criteria

Therapeutic Class	Reimbursement Criteria
Anticoagulants	Enoxaparin – See formulary for funded biosimilars Brand(s): Lovenox and biosimilars Dosage Form/Strength: Check formulary or e-formulary for funded products Tinzaparin Brand(s): Innohep Dosage Form/Strength: Check formulary or e-formulary for funded products For peri-operative bridging for patients who require long-term warfarin therapy and must temporarily discontinue it before and after surgery, and who are at moderate- to high-risk for an embolic event while off warfarin. Standard Approval Duration: As requested up to a maximum of 10 days before the date of surgery plus up to 7 days after surgery. For post-operative prophylaxis of DVT for patients who had hip or knee surgery, and cannot use warfarin. Standard Approval Duration: As requested up to a maximum of 30 days starting on the day of surgery. For the post-operative prophylaxis of venous thromboembolism following abdominal or pelvic surgery for cancer in patients who do not have a history of or risk factors for heparin-induced thrombocytopenia. Standard Approval Duration: Maximum of 30 days EAP Drug Request Form: Standard Form for EAP Drug Requests
Anticoagulants – Telephone Request Service (TRS) Drugs	Enoxaparin – see Formulary for funded biosimilars Brand(s): Lovenox and formulary listed biosimilars Dosage Form/Strength: 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg Injection Tinzaparin Brand(s): Innohep Dosage Form/Strength: 2,500 IU, 3,500 IU, 4,500 IU, 8,000 IU, 10,000 IU, 12,000 IU, 14,000 IU, 16,000 IU, 18,000 IU, 20,000 IU Injection NOTE: Low Molecular Weight Heparins (LMWHs) are currently listed on the ODB Formulary as Limited Use (LU) benefits for the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) in certain patient groups. Please consult the Formulary for further details. For peri-operative bridging for patients who require long-term warfarin therapy and must temporarily discontinue it before and after surgery, and who are at moderate- to high-risk for an embolic event while off warfarin. Standard Approval Duration: As requested, up to a maximum of 10 days before the date of surgery plus up to 7 days after the date of hospital discharge For post-operative prophylaxis of DVT for patients who had hip or knee surgery and cannot use warfarin. Standard Approval Duration: As requested, up to a maximum of 30 days starting on the day of surgery For the post-operative prophylaxis of venous thromboembolism following abdominal or pelvic surgery for cancer in patients who do not have a history of or risk factors for heparin-induced thrombocytopenia. Standard Approval Duration: Maximum of 30 days.

Product Monograph