CurrentAvMedPolicy N/A

Aliskiren (Tekturna) pharmacy prior authorization and step-edit

Form and criteria governing prior authorization/step-edit for aliskiren (Tekturna and Tekturna HCT) prescriptions for AvMed members; affects prescribers submitting PA requests.

Policy Summary

PayerAvMed

PolicyAliskiren (Tekturna) pharmacy prior authorization and step-edit

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and document trials of both an ACE inhibitor and an ARB for at least 30 days each with supporting chart notes or pharmacy claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30required trial duration (days)

2classes required

1forms requiring signature

Coverage Criteria — Aliskiren (Tekturna, Tekturna HCT)

Initial approval criteria

Covered when ALL of the following are met

Main criteria

Step therapy
- ACE inhibitor trial: ONE angiotensin-converting enzyme (ACE) drug or ACE combination drug (e.g., benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril).
- ARB trial: ONE angiotensin receptor blocker (ARB) drug or ARB combination drug (e.g., candesartan, losartan, irbesartan, olmesartan, telmisartan).

Documentation: Previous therapies must be verifiable by pharmacy paid claims or submitted chart notes; provide supporting documentation for each checked criterion.

Policy Summary

PayerAvMed

PolicyAliskiren (Tekturna) pharmacy prior authorization and step-edit

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and document trials of both an ACE inhibitor and an ARB for at least 30 days each with supporting chart notes or pharmacy claims.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for aliskiren (Tekturna) and Tekturna HCT; all clinical criteria must be met and documented for approval.

Covered drugs: aliskiren (Tekturna) and Tekturna HCT (aliskiren & hydrochlorothiazide).
Fax completed form and supporting documentation to 1-305-671-0200.

Step Therapy

Step Therapy Requirement

Member must have tried and failed at least 30 days of therapy with BOTH an ACE inhibitor (or ACE combination) AND an ARB (or ARB combination). Verification via chart notes or pharmacy paid claims is required.

Examples of ACE drugs: benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril.
Examples of ARB drugs: candesartan, losartan, irbesartan, olmesartan, telmisartan.
Use of samples to initiate therapy does not meet step edit/preauthorization criteria.

Documentation Required

Required Supporting Documentation

Provide documentation supporting each checked clinical criterion, including lab results, diagnostics, and chart notes; prior therapies will be documented (verified via pharmacy paid claims or submitted chart notes). Requests may be denied if supporting documentation is missing.

Include lab results, diagnostics, and chart notes that substantiate the clinical criteria checked on the form.
Document previous therapies and duration (e.g., 30 days) with dates and outcomes.

Documentation Required

Form Completion Requirements

Prescriber must sign and clearly print name on the request (preprinted stamps not valid); include member identifiers, prescriber NPI, contact phone and fax. All other information may be filled in by office staff.

Required fields: Member name, AvMed member number, date of birth, prescriber name, prescriber signature, date, office contact name, phone number, fax number, NPI.
Fax number for submission: 1-305-671-0200.

Denial Risk

Incomplete or Missing Documentation

Authorization can be delayed or the request may be denied if the form is incomplete, incorrect, illegible, or supporting documentation (lab results/notes) is missing.

Preprinted signature stamps are not valid.
If information provided is not complete, correct, or legible, the authorization process can be delayed.

Background

Aliskiren is a direct renin inhibitor used to treat hypertension. Prior authorization is required for aliskiren (Tekturna) and Tekturna HCT, and approval requires documented trials of other renin–angiotensin system agents. Specifically, the member must have tried and failed at least 30 days of therapy with BOTH an ACE inhibitor (or ACE combination) and an ARB (or ARB combination), verified by chart notes or pharmacy paid claims; use of samples does not satisfy this requirement. All clinical criteria must be met and supporting documentation (lab results, diagnostics, and chart notes) must be provided or the request may be denied.

Step Therapy Requirements

Requirement	Details
ACE inhibitor trial	Member has tried and failed at least 30 days of therapy with ONE angiotensin-converting enzyme (ACE) drug or ACE combination (e.g., benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril). Trial and failure must be verified by chart notes or pharmacy paid claims.
ARB trial	Member has tried and failed at least 30 days of therapy with ONE angiotensin receptor blocker (ARB) drug or ARB combination (e.g., candesartan, losartan, irbesartan, olmesartan, telmisartan). Trial and failure must be verified by chart notes or pharmacy paid claims.
Step therapy overall requirement	Both the ACE inhibitor trial and the ARB trial must be completed and documented prior to approval. Use of samples to initiate therapy does not meet step edit/preauthorization criteria.

OpenPayer

Aliskiren (Tekturna) pharmacy prior authorization and step-edit

Coverage Criteria — Aliskiren (Tekturna, Tekturna HCT)

Coding and Trial Durations

Provider Actions and Requirements

Background

Definitions

Initial Therapy Criteria

Step Therapy Requirements