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FSSA/OMPP wants to make Medicaid better for members and they need your help. Apply to join Indiana Medicaid’s NEW Beneficiary Advisory Council (BAC) to share your experience. The BAC, composed of current and former Medicaid members and caretakers, will discuss policy and program changes. To apply, complete the BAC application and submit it via email or mail. Additionally, here is the website link for the FSSA BAC page: https://www.in.gov/fssa/ompp/advisory-committees/beneficiary-advisory-council

Generic Brand HICL GCN Exception/Other

ALISKIREN FUMARATE

TEKTURNA

34493

 

 

Guidelines for Use

Our guideline named ALISKIREN FUMARATE (TEKTURNA) requires ONE of the following rule(s) be met for approval:

  1. You have a previous trial and failure of at least TWO angiotensin converting enzyme inhibitors (ACE-I: a type of drug used to protect kidneys such as benazepril, enalapril, fosinopril, lisinopril, quinapril, ramipril) and/or angiotensin receptor blocker agents (ARB: a type of drug used to protect kidneys such as irbesartan, losartan, olmesartan, telmisartan)
  2. Your doctor has submitted a medical reason for the use of the requested agent over other ACE inhibitors/ARB agents
  3. You have a history of the requested agent within the past 90 days, confirmed by claims history or chart documentation
Created: 8/16/2024 11:08:09 AM


Last Modified: Thursday, May 1, 2025