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.
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, Brand Azilsartan, Edarbyclor
Step Therapy
Length of Approval: When approved; no reauthorization required
- 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: When approved; no reauthorization required
- 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
2026-05-26, 2025-12-18, 2025-07-02, 2025-05-28, 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.
- Exforge HCT prescribing information. Novartis Pharmaceuticals Corp. East Hanover, New Jersey. May 2023.
Revision History
- 2026-05-26: 2026 Annual Review. Removal of obsolete products. Addition of new single source generic product of Edarbi to guideline.
- 2025-12-18: no criteria changes, added IL statute operational note
- 2025-07-02: 2025 Annual Review. No criteria changes. Removed obsolete GPIs.
- 2025-05-28: Removing reauthorization requirement as part of extended reauthorization program.
- 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