Diagnosis: Hypertension
Treatment: Edarbyclor 40/25mg (milligrams) Tablet
The insurer denied the Edarbyclor 40/25mg (milligrams)Tablet
The denial is upheld

The patient is a male with hypertension. No complaints of chest pain, palpitations, shortness of breath or dizziness. Also diagnosis of prediabetes. Appeal noted poor responses to ARB/HCTZ agents (Angiotensin receptor blockers/Hydrochlorothiazide) such as Benicar/HCTZ (hydrochlorothiazide), AMLODIPINE, AND MICARDIS. Presently uses combination of Azilsastin and Chlorthaidone, known as Edarbyclor.


Appeal letter states that no other medication on formulary can control blood pressure as well as Edarbyclor.

Formulary alternatives are: candesartan, candesartan-hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, olmesartan (generic Benicar), olmesartan-hydrochlorothiazide (generic Benicar HCT), telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide.

No, the health plan should not cover the proposed treatment.

There is no evidence in the literature to suggest that this fixed combination anti-hypertensive, Edarbyclor, would be superior to other medications is this clinical situation. This could also included other ARB (angiotensin-receptor blockers), ACE (angiotensin converting enzyme) and diuretic.

Also, there is no documented evidence of failure of other formulary drugs in the medical records. It would be reasonable to try other formulary drugs in various dosages prior to the exclusive use of Edarbyclor.

Many of the formulary medications should be effective in blood pressure control.