ANTICOAGULANTS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ELIQUIS 2.5 MG TABLET apixaban	00003089321 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ELIQUIS 2.5 MG TABLET apixaban	00003089331 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN
ELIQUIS 5 MG TABLET apixaban	00003089431 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN
ELIQUIS 5 MG TABLET apixaban	00003089470 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ELIQUIS 5 MG TABLET apixaban	00003089421 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ELIQUIS DVT-PE TREAT START 5MG apixaban	00003376474 BMS PRIMARYCARE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ENOXAPARIN 100 MG/ML SYRINGE enoxaparin sodium	60505079504 APOTEX CORP	Yes	No	Medicaid CHIP CSHCN HTWPlus
ENOXAPARIN 100 MG/ML SYRINGE enoxaparin sodium	00781326869 SANDOZ	Yes	No	Medicaid CHIP CSHCN
ENOXAPARIN 100 MG/ML SYRINGE enoxaparin sodium	68001046142 BLUEPOINT LABOR	Yes	No	Medicaid CHIP CSHCN
ENOXAPARIN 100 MG/ML SYRINGE enoxaparin sodium	00955101010 WINTHROP US	Yes	No	Medicaid CHIP CSHCN HTWPlus