Savaysa

Generic: edoxaban

15MG, 30MG, 60MG — Tablet

Anticoagulants — Injectable

Also known as: SAVAYSA TABS 15MG, 30MG, 60MG Savaysa 15 Mg Tablet Savaysa 30 Mg Tablet Savaysa 60 Mg Tablet
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 16 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Silver Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 4400 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
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