Angiotensin Receptor Blockers
Indications for Prior Authorization
Edarbi (azilsartan medoxomil)
-
For diagnosis of Hypertension
Indicated for the treatment of hypertension to lower blood pressure. Edarbi may be used alone or in combination with other antihypertensive agents.
Edarbyclor (azilsartan and chlorthalidone)
-
For diagnosis of Hypertension
Indicated for the treatment of hypertension, to lower blood pressure. Edarbyclor may be used in patients whose blood pressure is not adequately controlled on monotherapy. Edarbyclor may be used as initial therapy if a patient is likely to need multiple drugs to achieve blood pressure goals.
Tekturna HCT (aliskiren and hydrochlorothiazide)
-
For diagnosis of Hypertension
Indicated for the treatment of hypertension, to lower blood pressure. Tekturna HCT may be used in patients not adequately controlled with monotherapy. It may also be used as initial therapy in patients likely to need multiple drugs to achieve their blood pressure goals.
Exforge HCT (amlodipine, valsartan, hydrochlorothiazide)
-
For diagnosis of Hypertension
Indicated for the treatment of hypertension, to lower blood pressure.Limitations of use: Exforge HCT is not indicated for the initial therapy of hypertension.
Criteria
Edarbi, Edarbyclor, Tekturna HCT
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure (of a minimum 30-day supply) or intolerance to one of the following generics:
- benazepril
- captopril
- enalapril
- fosinopril
- lisinopril
- moexipril
- perindopril
- quinapril
- ramipril
- trandolapril
- benazepril-HCTZ
- captopril-HCTZ
- enalapril-HCTZ
- fosinopril-HCTZ
- lisinopril-HCTZ
- quinapril-HCTZ
- amlodipine-benazepril
- trandolapril-verapamil
- losartan
- losartan-HCTZ
- candesartan
- candesartan-HCTZ
- irbesartan
- irbesartan-HCTZ
- telmisartan
- telmisartan-HCTZ
- amlodipine-olmesartan
- olmesartan
- olmesartan-HCTZ
- olmesartan-amlodipine-HCTZ
Exforge HCT
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure (of a minimum 30-day supply) or intolerance to one of the following generics:
- amlodipine-olmesartan
- amlodipine-benazepril
- amlodipine-valsartan
- telmisartan-amlodipine
- trandolapril-verapamil
- benazepril-HCTZ
- candesartan-HCTZ
- captopril-HCTZ
- enalapril-HCTZ
- fosinopril-HCTZ
- lisinopril-HCTZ
- losartan-HCTZ
- olmesartan-HCTZ
- quinapril-HCTZ
- telmisartan-HCTZ
- olmesartan-amlodipine-HCTZ
P & T Revisions
2024-06-05, 2023-10-13, 2023-06-06, 2021-12-01, 2021-06-07, 2020-04-01
References
- Edarbi prescribing information. Azurity Pharmaceuticals. Atlanta, GA. January 2024.
- Edarbyclor prescribing information. Azurity Pharmaceuticals. Atlanta, GA. March 2023.
- Tekturna HCT prescribing information. Noden Pharma USA, Inc. Boston, MA. May 2023.
- Exforge HCT prescribing information. Novartis Pharmaceuticals Corp. East Hanover, New Jersey. May 2023.
Revision History
- 2024-06-05: 2024 Annual Review. Added "of a minimum 30-day supply" to trial and failure criteria. Removed Tekturna as a target from guideline. Background updates.
- 2023-10-13: GPI cleanup, no change to clinical intent.
- 2023-06-06: Annual review, no changes
- 2021-12-01: Program update to include Exforge HCT criteria
- 2021-06-07: Annual Review
- 2020-04-01: Reference updates only
HEALTHY LIVING