Pharmacy Prior Authorization Criteria

Kapspargo (metoprolol succinate)

Indications for Prior Authorization

Kapspargo (metoprolol succinate) capsules extended-release

• For diagnosis of Hypertension
  Indicated for the treatment of hypertension, to lower blood pressure.

• For diagnosis of Angina Pectoris
  Indicated in the long-term treatment of angina pectoris, to reduce angina attacks and to improve exercise tolerance.

• For diagnosis of Heart Failure
  Indicated to reduce the risk of cardiovascular mortality and heart-failure hospitalization in patients with heart failure.

Criteria

Kapspargo

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), contraindication, or intolerance to two of the following generics:
• metoprolol tartrate
• metoprolol succinate ER
• bisoprolol
• betaxolol
• carvedilol IR
• carvedilol ER
• labetalol
• atenolol
• acebutolol
• propranolol IR
• propranolol ER
• pindolol
• nadolol

P & T Revisions

2024-05-17, 2023-05-12, 2022-07-21, 2022-06-01, 2021-03-23

References

1. Kapspargo Prescribing Information. Sun Pharmaceutical Industries, Inc. Cranbury, NJ. April 2023.

---

Revision History

• 2024-05-17: 2024 Annual Review
• 2023-05-12: 2023 UM Annual Review. No criteria changes. Added in "of a minimum 30 day supply" to trial duration requirement and updated references
• 2022-07-21: Clarified authorization duration.
• 2022-06-01: Annual Review. Added FDA approved diagnosis requirement to criteria.
• 2021-03-23: 2021 UM Annual Review.

---