Alternatives to the sample closet in HTN

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Alternatives to the sample closet inHTN

• Dana G. Carroll, PharmD, BCPS
• March 27, 2007

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All costs obtained fromwww.drugstore.comwww.wal
mart.comwww.target.com
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HTN

• JNC 7
• HCTZ first line
• If SBP gt 20 points above goal then 2 drug regimen
• HCTZ plus
• Rx with compelling indication
• Beta Blocker
• ACEi or ARB
• Calcium Channel Blocker
• Others.

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Compelling indications.

• CHF
• ACEi, Beta Blocker, Diuretic
• ARB or Aldosterone Antagonist
• PostMI
• ACEi, Beta Blocker
• Aldosterone Antagonist
• CAD
• Beta Blocker, ACEi
• CCB, Diuretic

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Compelling indications.

• CVA
• Diuretic with either ACEi or ARB
• DM
• ACEi or ARB, Diuretic
• Beta Blocker, CCB
• CKD
• ACEi or ARB

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Diuretics and

• HCTZ (tablets)
• 100 25 mg 9
• 100 50 mg 9
• WM and Target 12.5, 25, 50 mg 30 for 4
• Chlorthalidone (Hygroton)
• 30 25 mg 9/mo
• 30 100 mg 9/mo
• WM and Target 35, 50 mg 30 for 4

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ACEi and

• Captopril (Capoten)
• 100 25 mg 15/mo
• 60 100 mg 17/mo
• WM and Target 12.5, 25, 50 and 100 mg 60 4
• Enalapril(Vasotec)
• 60 20 mg 25/mo
• WM and Target 2.5, 5, 10 and 20 mg 30 4
• Combo 5mg enalapril/ 12.5mg HCTZ 30 4
• Lisinopril (Zestril or Prinivil)
• 30 40 mg 25/mo
• 30 20 mg 17/mo
• WM and Target 2.5, 5, 10, 20 mg 30 4
• Combo 3 strengths available 30 4

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ACEi and

• Ramipril (Altace) NO GENERIC available
• 60 5 mg 77/mo
• 60 10 mg 93/mo
• Benazepril (Lotensin)
• 30 20 mg 25/mo
• 30 40 mg 25/mo
• WM and Target 5, 10, 20, 40 mg 30 4
• Fosinopril (Monopril)
• 30 20 mg 60-70
• 30 40 mg 60-70

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ACEi and

• Perindopril (Aceon)
• 4 and 8 mg 30 48
• Trandolapril (Mavik) (has generic)
• 2 and 4 mg 30 35
• Moexipril (Univasc)
• 7.5 and 15 mg 30 40

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ARB and

• Losartan (Cozaar)
• 30 25 mg or 50 mg 43/mo
• 30 100 mg 58/mo
• Candesartan (Atacand)
• 30 4 mg or 8 mg 43/mo
• 30 32 mg 54/mo
• Telmisartan (Micardis)
• 28 40 mg or 80 mg 43/mo
• All will be similar in price and very vs
  ACEi
• Avapro, Benicar, Cozaar, Diovan, Micardis,
  Teveten are all covered as brand preferred.
• None are covered in the 4 program with WM and
  Target.
• Some do come as combo with HCTZ.

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BB and

• Atenolol (Tenormin)
• 90 25 mg or 50 mg 11
• WM and Target 25, 50, 100mg and combo with
  chlorthalidone (50/25 and 100/25) 30 4
• Metoprolol
• Lopressor 60 50 mg or 100 mg 10-15/mo
• WM and Target 25, 50, 100 60 for 4
• Only generic
• Toprol XL 30 50 mg or 100 mg 23-32/mo

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BB and

• Propranolol
• Inderal 100 20 mg 8/mo
• 60 40 or 80 mg 8-14/mo
• WM and Target 10, 20, 40, 80 60 4
• Only generic
• Inderal LA 30 60 mg 40/mo
• 30 120 mg 52/mo
• Carvedilol (Coreg)
• 6.25 and 25 mg 60 95/mo

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CCB-nonDHP and

• Diltazem
• Cardizem 120 30 mg 15/mo
• 120 90 mg 21/mo
• Cardizem CD 30 120 mg 42/mo
• 30 240 mg 70/mo
• WM and Target 30, 60, 90 mg 60 4
• 120 mg 30 4
• Generic only for short and long acting (Cardizem
  CD and Dilacor XR)

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CCB-nonDHP and

• Verapamil
• Verapamil 90 40- 120mg 10/mo
• WM and Target 80 and 120 mg 30 4
• Calan SR 30 120 mg 36/mo
• 30 240 mg 56/mo
• Generic only for short and long acting (Calan SR
  and Isoptin SR)

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CCB DHP and

• Nifedipine
• Never use short acting for HTN management!
• Adalat CC 30 30-60mg 40-70/mo
• Nicardipine
• Never use short acting for HTN management!
• Cardene SR 60 30-90 mg 54-98/mo
• Amlodipine (Norvasc- requires PA w/ Ala MC)
• 30 2.5-5 mg 42/mo
• 30 10mg 60/mo
• Felodipine (Plendil- requires PA w/ Ala MC)
• 30 2.5-5 mg 35/mo
• 30 10 mg 60/mo

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CCB DHP and

• Dynacirc CR (Isradapine)
• Preferred brand
• Sular (Nisolodipine)
• Preferred brand

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Aldosterone Antagonists and

• Spironolactone (Aldactone)
• 25mg 30 10
• 50mg 30 20
• 100mg 30 35
• WM and Target 25 mg 30 4
• Eplerenone (Inspra)- requires PA AL Medicaid
• 25mg 30 105
• 50mg 30 105

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Peripheral Alpha Blockers and

• Doxazosin (Cardura)
• 2mg, 4mg, 8mg 30 20-24
• Prazosin (Minipress)
• 1mg, 2mg, 5mg 30 (capsule) 14-26
• Terazosin (Hytrin)
• 1mg, 2mg, 5mg, 10mg 30 14
• WM and Target All 3 covered in all strengths
• 30 4

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2nd line agents and

• Clonidine( generic tablets only)
• Catapres 60 0.1-0.3 mg 11-15/mo
• WM and Target 0.1and 0.2mg 30 4
• Catapres TTS 0.1mg 50/mo
• 0.2 mg 80/mo
• 0.3 mg 112/mo
• Requires PA AL Medicaid

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2nd line agents and

• Methyldopa (Aldomet)
• 250 mg and 500 mg 60 14
• WM and Target 250 mg 60 and 500 mg 30 4
• Hydralazine (Apresoline)
• 25mg 30 8
• 100mg 30 20
• WM and Target 10mg and 25mg 30 4
• Minoxidil (Loniten)
• 2.5mg 60 20
• 10mg 60 36

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