ALISKIREN FUMARATE/HYDROCHOLORTHIAZIDE (TEKTURNA HCT)

Guidelines for Use

Our guideline named ALISKIREN FUMARATE/HYDROCHLOROTHIAZIDE (TEKTURNA HCT) requires ONE of the following rule(s) be met for approval:

1. You have a previous trial and failure of at least TWO angiotensin converting enzyme inhibitors (ACE-I: a type of drug used to protect kidneys such as benazepril, enalapril, fosinopril, lisinopril, quinapril, ramipril) and/or angiotensin receptor blockers (ARB: a type of drug used to protect kidneys such as irbesartan, losartan, olmesartan, telmisartan) and/or direct renin inhibitor (such as aliskiren)
2. Your doctor has submitted a medical reason for the use of the requested agent over other ACE inhibitors/ARB agents/direct renin inhibitors
3. You have a history of the requested agent within the past 90 days, confirmed by claims history or chart documentation