An unknown in the outpatient arena remains drug formulary coverage for Pradaxa, and now Xarelto. Although formularies vary, even within a single insurer, many still do not have Pradaxa on formulary. On 7/1/2011 I received a fax from United Healthcare, stating that Pradaxa was non-formulary for a patient with atrial fibrillation.
PBMs will have a tough time listing/approving/covering Xarelto (or perhaps Pradaxa in the future) for post-ortho DVT prevention and turning around and not covering it for chronic Afib.
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