Pharmacy Prior Authorization Criteria

Tryvio (aprocitentan)

For diagnosis of Hypertension
Indicated for the treatment of hypertension in combination with other antihypertensive drugs, to lower blood pressure in adult patients who are not adequately controlled on other drugs. Lowering blood pressure reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions.

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)

AND

Requested drug will be used as part of combination therapy with at least 3 antihypertensive medications (e.g., lisinopril, indapamide)

AND

Patient has not achieved adequate blood pressure control (e.g., systolic blood pressure [SBP] less than 130 mmHg) after treatment with at least three non-mineralocorticoid receptor antagonist (non-MRA) antihypertensive medications from different classes at target doses (e.g., angiotensin converting enzyme [ACE] inhibitor [e.g., captopril] or angiotensin II receptor blocker [ARB] [e.g., candesartan], thiazide-type or thiazide-like diuretic [e.g., hydrochlorothiazide, chlorthalidone], calcium channel blocker [e.g., nifedipine]) [A, B]

AND

Trial and inadequate response, contraindication, or intolerance to a mineralocorticoid receptor antagonist (MRA) (e.g., eplerenone, spironolactone) [A]

AND

Provider attests other causes of hypertension have been addressed (e.g., secondary causes [e.g., primary hyperaldosteronism] ruled out, medication nonadherence) [2, 3]

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

Patient demonstrates positive clinical response to therapy (e.g., systolic blood pressure [SBP] less than 130 mmHg)

AND

Patient continues to use Tryvio as part of combination therapy with at least 3 antihypertensive medications (e.g., lisinopril, indapamide) and is adherent to therapy

2026-08-24, 2026-05-26, 2025-08-06, 2024-09-19, 2024-09-06

Tryvio Prescribing Information. Idorsia Pharmaceuticals US Inc. Radnor, PA. September 2025.
Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5).
Writing Committee Members, Jones DW, Ferdinand KC, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. 2025; 82(10):e212-e316.

The 2025 ACC/AHA guideline recommends the addition of an MRA to control blood pressure in adults with uncontrolled resistant hypertension despite optimized therapy with first-line antihypertensives (i.e., combination of ACE inhibitor/ARB, calcium channel blocker, and thiazide-like diuretic). In patients who cannot tolerate or have contraindications to MRAs, other agents/classes, including dual endothelin receptor antagonists like Tryvio, are considered reasonable to use to control blood pressure. [3]
Target doses of antihypertensives refer to the lower of the two dosages: patient’s maximally tolerated dose or usual dose ranges recommended by clinical practice guidelines that have demonstrated efficacy in blood pressure reduction (e.g., lisinopril 10-40 mg, olmesartan 20-40 mg). [3]

2026-08-24: Specified diagnosis is resistant hypertension. Revised embedded step through all agents to: 1) attestation of inadequate blood pressure control with at least 3 nonMRA agents, and 2) trial through MRA. Removed lifestyle modification criteria. Removed trial requirement from reauth.
2026-05-26: Annual Review 2026 - Specified diuretic trial requirement is thiazide/thiazide-type. Removed prescriber requirement. Background updates.
2025-08-06: 2025 Annual Review. No criteria changes, updated references
2024-09-19: Minor update
2024-09-06: New Program