Diagnosis: Deep Vein Thrombosis
Treatment: Eliquis

The health plan denied the requested prescription drug Eliquis.
The health plan's determination is upheld.

This is a male with a left lower extremity deep vein thrombosis on long term anticoagulation with Eliquis. Eliquis was denied as the formulary alternatives are Warfarin and Xarelto; this is under review.

The health plan's determination is upheld, in whole.

Neither Xarelto nor Warfarin have been demonstrated to be inferior to Eliquis. The included documentation does not indicate that this patient is intolerant of either of the formulary alternatives nor that he has failed them; similarly, there is a paucity of documentation indicating this patient has a contraindication to the formulary alternatives. Neither the authors of UpToDate nor the peer-reviewed literature recommend one of these agents as being superior to another and thus given their relative equivalency, the formulary options are reasonable and would not have adverse effects that the non-formulary alternative would.