Diagnosis: Cardiac/Circulatory Problems-Hypertension/High Blood Pressure
Treatment: Pharmacy/Prescription Drugs-Nebivolol
The health plan denied coverage of the prescription medication Nebivolol as the patient did not meet their formulary exception criteria. The reviewer has overturned the health plan's determination.

This case involves a patient with a history of hypertension and hyperlipidemia who has been treated with several antihypertensive medications to achieve adequate blood pressure control. However, the patient has had documented intolerances and significant side effects to formulary medications, metoprolol, propranolol, and nadolol prompting their discontinuation. The patient has tolerated well the non-formulary medication, nebivolol.
The patient has demonstrated significant side effects to the formulary medications, metoprolol, nadolol, propranolol, prompting their discontinuation in the past. In addition, patient is tolerating nebivolol very well without side effects and is helping the patient control his blood pressure. For these reasons, prescription coverage for nebivolol should be granted because it is a superior alternative for this patient to maintain good blood pressure control (1). I recommend that the health plan's determination be overturned, and that coverage be granted for non-formulary medication, nebivolol, since the patient has met the plans non-formulary prescription medication criteria as discussed above.