CaroSpir (spironolactone oral suspension) — Highmark
Add-on therapy for the treatment of hypertension
Preferred products
- generic spironolactone tablets
- generic spironolactone oral suspension
Initial criteria
- age ≥ 18 years
- Diagnosis of heart failure with reduced ejection fraction (ICD10: I50.2) OR add-on therapy for the treatment of hypertension (ICD10: I10) OR management of edema in adult cirrhotic patients (ICD10: K74) when edema is not responsive to fluid and sodium restrictions
- Inability to swallow tablets
- Therapeutic failure or intolerance to plan-preferred, generic spironolactone tablets
- If request is for brand CaroSpir, therapeutic failure or intolerance to generic spironolactone oral suspension
Reauthorization criteria
- Prescriber attests that member has experienced positive clinical response to therapy
- Prescriber attests that member continues to have an inability to swallow tablets
- If request is for brand CaroSpir, therapeutic failure or intolerance to generic spironolactone oral suspension
Approval duration
12 months