Medicare AdvantagePrior AuthMedium impact
Angiotensin Blocking Agents (Revised)
Humana·Cardiology, Nephrology, Endocrinology +4 more·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jul 22, 2026
Summary
This is a revised Step Therapy policy for Angiotensin Blocking Agents (Arbli, azilsartan, Edarbi, Edarbyclor, and valsartan oral solution) under Medicare Advantage. The policy requires members to have prior treatment with at least two ACE inhibitors or ARBs before coverage is approved for the listed angiotensin blocking agents. This represents a gatekeeping requirement for pharmacy coverage.
Action Required
Before January 1, 2023 (retroactive to current date for ongoing claims): Billing and pharmacy teams must implement step therapy verification for all Humana Medicare Advantage members requesting Arbli, azilsartan, Edarbi, Edarbyclor, or valsartan oral solution. Establish a prior authorization workflow that: (1) Requires documentation of at least two prior treatments from the listed ACE inhibitors/ARBs (lisinopril, ramipril, benazepril, quinapril, enalapril, losartan, valsartan, irbesartan, or olmesartan, with or without HCTZ combinations), (2) Submits step therapy verification to Humana before dispensing covered drugs, (3) Denies or delays claims lacking evidence of two prior antihypertensive treatments. Update pharmacy system rules and prior authorization templates. Coordinate with providers to document treatment history on prescription requests. Claims submitted without step therapy verification will face delays or denials.