Diagnosis: Hypertension.
Treatment: Edarbyclor (azilsartan-chlorthalidone).
The insurer denied coverage for Edarbyclor (azilsartan-chlorthalidone).
The denial is upheld.

This is a patient with a history of hypertension, asthma, and obstructive sleep apnea. Hypertension was treated with propranolol and Edarbyclor therapies. Coverage for renewal of Edarbyclor (azilsartan-chlorthalidone) was denied. There was no information stating that patient could not tolerate alternatives on the formulary such as Losartan hydrochlorothiazide, Olmesartan-hydrochlorothiazide, or Valsartan-hydrochlorothiazide.

The formulary drugs are not likely to cause an adverse reaction. According to American Heart Association/American College of Cardiology (AHA/ACC) and European Society guidelines for the treatment of hypertension, Valsartan is a primary agent for treatment. (Reference 1,2) In this case, there is no documentation of inefficacy or intolerance to formulary medications. In conclusion, there is no reason to believe that the formulary drugs would be less effective than Edarbyclor.

The insurer's denial of coverage for Formulary Exception for Edarbyclor 40/12.5 mg (milligram) tablet (azilsartan-chlorthalidone) is upheld.