Pharmacy Prior Authorization Criteria

Baxfendy (baxdrostat) - PA, NF

Indications for Prior Authorization

Baxfendy (baxdrostat)

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

Criteria

Baxfendy

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)

• Diagnosis of one of the following: [A]
• Uncontrolled hypertension
• Resistant hypertension
AND
• Requested drug will be used as part of combination therapy with other antihypertensive medication(s) (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 two 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
• Requested drug will not be used in combination with an MRA (e.g., eplerenone, spironolactone) or potassium-sparing diuretic (e.g., triamterene, amiloride)
AND
• Provider attests to both of the following [C]:
• Patient’s serum potassium and risk of hyperkalemia have been assessed
• Any serum potassium abnormalities have been corrected prior to initiation of Baxfendy therapy
AND
• Provider attests other causes of hypertension have been addressed (e.g., secondary causes ruled out, medication nonadherence) [2, 3]
AND
• Prescribed by or in consultation with a specialist experienced in the treatment of uncontrolled or resistant hypertension (e.g., cardiologist, nephrologist)

Baxfendy

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 Baxfendy as part of combination therapy with other antihypertensive medication(s) (e.g., lisinopril, indapamide)
AND
• Trial and inadequate response, contraindication, or intolerance to a mineralocorticoid receptor antagonist (MRA) (e.g., eplerenone, spironolactone) [A]
AND
• Requested drug is not being used in combination with an MRA (e.g., eplerenone, spironolactone) or potassium-sparing diuretic (e.g., triamterene, amiloride)

Baxfendy

Non Formulary

Length of Approval: 6 Month(s)

• Submission of medical records (e.g., chart notes) confirming diagnosis of one of the following: [A]
• Uncontrolled hypertension
• Resistant hypertension
AND
• Paid claims or submission of medical records (e.g., chart notes) confirming Baxfendy will be used as part of combination therapy with other antihypertensive medication(s) (e.g., lisinopril, indapamide)
AND
• Submission of medical records (e.g., chart notes) confirming patient has not achieved adequate blood pressure control (e.g., systolic blood pressure [SBP] less than 130 mmHg) after treatment with at least two non-mineralocorticoid receptor antagonist (non-MRA) antihypertensive medications from different classes at target doses [A, B]
AND
• Paid claims or submission of medical records (e.g., chart notes) confirming trial of all of the following antihypertensive medications from different classes, unless there is a contraindication or intolerance to these medications, for an adequate duration (minimum 4 weeks each) at a maximally tolerated dose: [A]
• 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)
• Mineralocorticoid receptor antagonist (MRA) (e.g., eplerenone, spironolactone)
AND
• Submission of medical records (e.g., chart notes) or absence of paid claims confirming Baxfendy will not be used in combination with an MRA (e.g., eplerenone, spironolactone) or potassium-sparing diuretic (e.g., triamterene, amiloride)
AND
• Provider attests to both of the following [C]:
• Patient’s serum potassium and risk of hyperkalemia have been assessed
• Any serum potassium abnormalities have been corrected prior to initiation of Baxfendy therapy
AND
• Provider attests other causes of hypertension have been addressed (e.g., secondary causes ruled out, medication nonadherence) [2, 3]
AND
• Prescribed by or in consultation with a specialist experienced in the treatment of uncontrolled or resistant hypertension (e.g., cardiologist, nephrologist)

P & T Revisions

1970-01-01, 2026-07-24, 2026-05-26, 2025-08-06, 2024-09-19, 2024-09-06

References

1. Baxfendy Prescribing Information. AstraZeneca Pharmaceuticals LP. Wilmington, DE. May 2026.
2. 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.
3. Flack JM, Azizi M, Brown JM, et al; BaxHTN Investigators. Efficacy and safety of baxdrostat in uncontrolled and resistant hypertension. N Engl J Med. 2025; 393(14):1363-1374.

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End Notes

1. In the BaxHTN study, included participants had either uncontrolled hypertension (taking stable regimen of 2 antihypertensive medications from different therapeutic classes at maximum tolerated doses for 4 weeks without meeting blood pressure goals) or resistant hypertension (taking at least 3 antihypertensive medications from different therapeutic classes at maximum tolerated doses for 4 weeks without meeting blood pressure goals). [3]
2. 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). [2]
3. Serum potassium should be monitored prior to initiation of Baxfendy treatment and periodically during treatment, with more frequent monitoring recommended for patients at increased risk of hyperkalemia (e.g., patients 65 years of age or older, patients with diabetes mellitus or chronic kidney disease, patients taking concomitant medications that increase serum potassium [e.g., ACE inhibitors]). If patient experiences hyperkalemia while taking Baxfendy, the hyperkalemia should be treated and interruption/discontinuation of therapy should be considered. Patients who restart Baxfendy after experiencing hyperkalemia should receive more frequent monitoring. Baxfendy should be discontinued if clinically significant hyperkalemia recurs.

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Revision History

• 2026-07-24: New program
• 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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