Angiotensin Receptor Blockers (e.g., Atacand, Atacand HCT, Benicar, Benicar HCT, Tribenzor, Edarbi, Edarbychlor, Micardis, Micardis HCT, Teveten)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Hypertension
  • Heart Failure (Atacand)
  • Cardiovascular risk reduction (Micardis)

Patients must meet the following criteria for the above indication(s):

  • Tried and failed two preferred angiotensin receptor blockers (ARBs) or ARB combinations (losartan, valsartan or irbesartan) as supported by medical record documenation or prescription claims history

Dosing:

  • Adult dosing:
    • Atacand/Atacand HCT: candesartan max dose: 32 mg daily
    • Benicar/Benicar HCT/Tribenzor: olmesartan max dose: 40 mg daily
    • Edarbi: max dose: 80 mg daily
    • Edarbychlor: azilsartan max dose: 40 mg daily
    • Micardis/Micardis HCT: telmisartan max dose: 80 mg daily
    • Teveten: eprosartan max dose: 800 mg daily

Approval:

  • One year