tolvaptan (generic of Samsca) — Medical Mutual

Initial criteria

• Patient has a serum sodium < 125 mEq/L at baseline OR patient has serum sodium < 135 mEq/L at baseline that is symptomatic (e.g., nausea, vomiting, headache, lethargy, confusion) and has resisted correction with fluid restriction OR patient has already been started on generic tolvaptan and has received < 30 days of therapy

Approval duration

30 days