Angiotensin Receptor Blockers (ARBs) (EDARBI, EDARBYCLOR, VALSARTAN ORAL SOLUTION)

Angiotensin Receptor Blockers (ARBs) (EDARBI, EDARBYCLOR, VALSARTAN ORAL SOLUTION)

Self-Administration - Oral

Diagnosis considered for coverage:

• Indicated for the treatment of hypertension to lower blood pressure

Coverage Criteria:

For treatment of hypertension:

• Tried and failed two generic angiotensin receptor blockers (ARBs) or ARB combinations as supported by medical record documentation or prescription claims history

Dosing:

• Maximum Adult Dosing:
  • Edarbi: 80 mg once daily
  • Edarbyclor: 40/25 mg once daily
  • Valsartan oral solution: 320 mg daily

Coverage Duration:

• One year

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy do not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

Additional Information:

Generic ARBs:

• candesartan
• candesartan; HCTZ
• irbesartan
• irbesartan; HCTZ
• losartan
• losartan; HCTZ
• olmesartan
• olmesartan; HCTZ
• olmesartan; amlodipine
• olmesartan; amlodipine; HCTZ
• telmisartan
• telmisartan; HCTZ
• telmisartan; amlodipine
• valsartan
• valsartan; HCTZ
• valsartan; amlodipine
• valsartan; amlodipine; HCTZ

Policy Updates:

• 08/24/2020 – Policy reviewed, no changes.
• 12/01/2023 – Remove step therapy for all ARBs except Edarbi, Edarbyclor, and Valsartan oral solution (ABA). (P&T 11/14/23)