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Drug -  Savaysa™ (edoxaban tablets) [Daiichi Sankyo Co., LTD]

December 2015

Therapeutic Area - Anticoagulants

Approval criteria

Approval Criteria: Nonvalvular atrial fibrillation

The patient must meet criteria as follows:

  • Has diagnosis of nonvalvular atrial fibrillation
  • Creatinine clearance is < 90mL/min 

In addition, the patient must meet one step in section A and one step in section B below:

  • Section A: 
    • Prior stroke (ischemic or unknown), transient ischemic attack (TIA) or non-CNS system embolism
    • Has two or more of the following risk factors: hypertension, heart failure or left ventricular ejection fraction ≤35%, diabetes mellitus 
  • Section B:
    • Has a documented clinical intolerance or contraindication to warfarin 
    • Has tried a two-month trial of warfarin and, despite standard of care, was not well controlled

Approval Criteria: Deep vein thrombosis (DVT)

Patient has a diagnosis of deep vein thrombosis.

Approval Criteria: Pulmonary embolism (PE)

Patient has a diagnosis of pulmonary embolism.

Quantity limits

Maximum one tablet daily (34 tablets per 34 days)


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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