Prior Authorization

Antihypertensives (drugs to treat high blood pressure)

There are multiple generic medications available to treat high blood pressure. Medical guidelines support using one of the generic drugs before using a brand-name angiotensin converting enzyme inhibitor (ACE Inhibitor), angiotensin-II receptor blocker (ARB) or renin inhibitor (RI). 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.

Brand Medications Requiring Prior Authorization Generic Medications

ACE Inhibitors & Combinations

Accupril, Accuretic, Aceon, Altace, Capoten, Capozide, Lexxel, Lotensin, Lotensin HCT, Lotrel, Mavik, Prinivil, Prinzide, Tarka, Univasc, Uniretic, Vaseretic, Vasotec, Zestril, Zestoretic

  • benazepril
  • benazepril/amlodipine
  • benazepril/HCTZ
  • captopril
  • captopril/HCTZ
  • enalapril
  • enalapril/HCTZ
  • felodipine ER
  • fosinopril
  • fosinopril/HCTZ
  • lisinopril
  • lisinopril/HCTZ
  • losartan
  • losartan/HCTZ
  • moexipril
  • moexipril/HCTZ
  • perindopril
  • quinapril
  • quinapril/HCTZ
  • ramipril
  • trandolapril
  • trandolapril/verapamil ER

ARB & Combinations

Atacand, Atacand HCT, Avalide, Avapro, Azor, Benicar, Benicar HCT, Cozaar, Diovan, Diovan HCT, Edarbi, Exforge, Exforge HCT, Hyzaar, Micardis, Micardis HCT, Teveten, Teveten HCT, Tribenzor, Twynsta,

RI & Combinations

Amturnide, Tekamlo, Tekturna, Tekturna HCT, Valturna

 

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