Prior Authorization

Drugs to treat high blood pressure

Many generic ACE Inhibitors are available to treat high blood pressure. Medical guidelines support using one of the generic drugs before using a brand-name ACE Inhibitor and before using a class of drugs called ARBs. Formulary and non-formulary brand-name drugs will require a prior authorization unless one of the available generic drugs has been tried first. An electronic claim edit at the pharmacy will determine if a member has been receiving the brand-name medication or has tried a required generic. In either case, the requested brand-name drug will be approved. Members new to BCBSKS prescription drug coverage will not have a claim history to automatically approve the brand-name drugs. Therefore, a prior authorization process is in place to provide a manual review of claims that do not meet the electronic edit.

The table below shows the generic drugs available, as well as, the brand-name drugs that will require a prior authorization if a generic has not been used.

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