Pharmacy Prior Authorization Criteria

Tryvio (aprocitentan)

Indications for Prior Authorization

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.

Criteria

Tryvio

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)

• Diagnosis of hypertension
AND
• Patient has not achieved target blood pressure (e.g., systolic blood pressure [SBP] less than 130 mmHg) after treatment with all of the following antihypertensive medications from different classes for an adequate duration (minimum 4 weeks each) at a maximally tolerated dose: [A]
• One of the following:
• Angiotensin converting enzyme (ACE) inhibitor (e.g., captopril, enalapril)
• Angiotensin II receptor blocker (ARB) (e.g., candesartan, valsartan)
AND
• Thiazide-type or thiazide-like diuretic (e.g., hydrochlorothiazide, chlorthalidone)
AND
• Calcium channel blocker (e.g., amlodipine, nifedipine)
AND
• Mineralocorticoid receptor antagonist (MRA) (e.g., eplerenone, spironolactone)
AND
• Provider attests other causes of hypertension have been excluded (e.g., secondary causes [e.g., primary hyperaldosteronism], white coat effect, medication nonadherence) [2, 3]
AND
• Used as an adjunct to lifestyle modification (e.g., dietary or caloric restriction, exercise, behavioral support, community-based program) [2, 3]
AND
• Requested drug will be used in combination with at least 3 antihypertensive medications from different classes

Tryvio

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 in combination with at least 3 antihypertensive medications from different classes and is adherent to therapy
AND
• Requested drug will continue to be used as an adjunct to lifestyle modification (e.g., dietary or caloric restriction, exercise, behavioral support, community-based program) [2, 3]
AND
• Patient has been previously treated with all of the following antihypertensive medications from different classes for an adequate duration (minimum 4 weeks each) at a maximally tolerated dose: [A]
• One of the following:
• Angiotensin converting enzyme (ACE) inhibitor (e.g., captopril, enalapril)
• Angiotensin II receptor blocker (ARB) (e.g., candesartan, valsartan)
AND
• Thiazide-type or thiazide-like diuretic (e.g., hydrochlorothiazide, chlorthalidone)
AND
• Calcium channel blocker (e.g., amlodipine, nifedipine)
AND
• Mineralocorticoid receptor antagonist (MRA) (e.g., eplerenone, spironolactone)

P & T Revisions

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

References

1. Tryvio Prescribing Information. Idorsia Pharmaceuticals US Inc. Radnor, PA. September 2025.
2. 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).
3. 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.

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End Notes

1. 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]

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Revision History

• 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

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