Limited coverage criteria - Angiotensin receptor blockers – irbesartan

Last updated on March 18, 2025

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Generic name		irbesartan, including in combination with hydrochlorothiazide
Strength & form		75 mg, 150 mg, 300 mg, 150 mg/12.5 mg, 300 mg/12.5 mg, 300 mg/25 mg tablet

Special Authority Criteria	Approval period
Person identified as experiencing intractable cough or angioedema on an angiotensin-converting enzyme inhibitor (ACE-I) AND Failure on optimal doses of, or intolerance to, ALL reference drugs: candesartan, losartan, telmisartan AND valsartan	Indefinite

Special Authority Criteria

Approval period

Person identified as experiencing intractable cough or angioedema on an angiotensin-converting enzyme inhibitor (ACE-I)

AND

Failure on optimal doses of, or intolerance to, ALL reference drugs: candesartan, losartan, telmisartan AND valsartan

Indefinite

Practitioner exemptions

No practitioner exemptions

Special notes

Individuals requiring a diuretic combination product must satisfy the same criteria

Special Authority request form(s)

Log in to eForms
HLTH 5492 – ARBs - RDP Program (PDF, 672KB)

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