Medically Necessary — FDA-Approved Indication (Hypertension)
Defines Cigna prior-authorization and medical necessity criteria for Tryvio (aprocitentan tablets) for adults with hypertension when used in combination with other antihypertensive medications.
Requirement changed from trying at least four other antihypertensive agents from four different pharmacologic classes to trying at least three other antihypertensive agents from at least three different pharmacologic classes.
New policy created and effective with initial review date 08/14/2024.
Medical Necessity Criteria for Tryvio (aprocitentan)
Medically Necessary 96 FDA-Approved Indication (Hypertension)
Approve for 1 year if the patient meets BOTH of the following (A and B):
Prior authorization is recommended; approvals are provided for 1 year when criteria are met.
Not Covered
Conditions considered not medically necessary
ANY of the following
- Use of Tryvio for any indication other than the FDA-approved indication of hypertension (until criteria updated with new published data)
Policy explicitly states not medically necessary for any other uses.
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