Tryvio — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years
• Patient has tried, or is currently receiving, at least four other antihypertensive agents for the treatment of hypertension from at least four of the following pharmacological classes: angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), non-dihydropyridine calcium channel blocker, dihydropyridine calcium channel blocker, diuretic, mineralocorticoid receptor antagonist, beta blocker, alpha-adrenergic blocker, central alpha-adrenergic agonist, direct vasodilator, direct renin inhibitor

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year initial, 1 year reauth