Conjupri (levamlodipine) — Highmark
hypertension
Preferred products
- amlodipine
- felodipine extended-release
- nifedipine extended-release
Initial criteria
- age ≥ 6 years
- diagnosis of hypertension (ICD-10: I10)
- therapeutic failure or intolerance to two of the following plan-preferred generic products, or all are contraindicated: amlodipine, felodipine extended-release, nifedipine extended-release
- If request is for brand Conjupri, therapeutic failure or intolerance to generic levamlodipine tablets
Reauthorization criteria
- prescriber attests that the member has achieved a reduction in blood pressure from baseline
- If request is for brand Conjupri, therapeutic failure or intolerance to generic levamlodipine tablets
Approval duration
12 months