Diagnosis: Hypertension.
Treatment: Edarbi 80 mg (milligrams).

The insurer denied coverage for Edarbi 80 mg. The denial is upheld.

This male patient has a history of hypertension and type I diabetes mellitus. Blood pressure has been well controlled [120/80 mm/Hg (millimeters of mercury)] on Edarbi [Azilsartan 80 mg (milligrams)]. The patient's physician has requested that the patient be continued on this medication and provides documentation that the patient's blood pressure has been stable on this regimen for many years. No documentation is provided regarding treatment with formulary alternatives.

The use of angiotensin receptor blockers to treat hypertension has been well described and is recommended by the AHA (American Heart Association) and ACC (American College of Cardiology). [Reference 1] Azilsartan is an angiotensin receptor blocking agent and this family of medications reduce cardiovascular morbidity and mortality in patients with hypertension. [Reference 2] Moreover, they reduce albuminuria in patients with diabetes mellitus. [Reference 2] Comparison of efficacy between different angiotensin blocker agents, including those on formulary, show no appreciable difference in controlling blood pressure. [Reference 3]

The formulary drugs are not likely to cause an adverse reaction for this patient. There is no evidence that the formulary drugs have been utilized and or failed to control the patient's blood pressure. There is no evidence that the requested drug would be more effective than any of the formulary drugs. In conclusion, the requested drug should not be approved.

The insurer's denial of coverage for Formulary Exception for Edarbi 80 mg is upheld.