amlodipine/valsartan/hydrochlorothiazide (generic Exforge HCT) — United Healthcare

Preferred products

• amlodipine/valsartan (generic Exforge)
• hydrochlorothiazide

Initial criteria

• Patient has a history of a trial resulting in therapeutic failure (blood pressure goal not met) to both of the following taken concomitantly: amlodipine/valsartan (generic Exforge) AND hydrochlorothiazide
• Patient is unable to adhere to antihypertensive therapy AND prescriber determines combination therapy would be beneficial

Reauthorization criteria

• Documentation of positive clinical response to therapy

Approval duration

12 months