tolvaptan — CareFirst (Caremark)

Initial criteria

• Therapy was initiated (or re-initiated) in the hospital for hypervolemic or euvolemic hyponatremia
• Serum sodium was less than 125 mEq/L or serum sodium was less than 135 mEq/L with symptoms (e.g., nausea, vomiting, headache, lethargy, confusion) at the time of therapy initiation
• The member will not receive the requested drug continually for greater than 30 days

Approval duration

30 days