Toolkit for Implementing the Chronic Care Model in an Academic Environment: Diabetes Planned Visit Notebook

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Diabetes Planned Visit Notebook

Blood Pressure Control Medication

Diabetes planned visits address several health topics of concern to the diabetic patient, including high blood pressure. This document, created by the Summa Health System, provides an overview of available blood pressure medications and Medicaid coverage.

Medicaid Coverage/ Summa Tier	Medication/Dose Availability	Titration Schedule
ACE
Medicaid covers Summa Tier 1	Captopril (Capoten) 12.5mg, 25mg, 50mg, 100mg
	Start 12.5mg Q 8H, Increase every two weeks	25mg Q 8H, 50mg Q 8H, 75mg Q8H, 100mg Q8H, 125mg Q8H, MAX 150mg Q 8H
		Goal DM nephropathy 25mg Q 8H
		GFR <50 give Q 12H
Medicaid covers Summa Tier 1	Enalapril (Vasotec) 2.5mg, 5mg, 10mg, 20mg 40mg
Medicaid covers Summa Tier 1	Start 5 mg QD Increase Q 2 weeks	10mg QD, 20mg QD, 30mg QD Max 40mg daily
Medicaid covers Summa Tier 1	Lisinopril (Zestril, Prinivil) 2.5mg, 5mg, 10mg, 20mg, 40mg
Medicaid covers Summa Tier 1	Start 5mg QD Increase Q 2 weeks	10mg QD, 20mg QD, 40mg QD Max 80mg QD
Not covered Medicaid Summa Tier 3	Quinapril (Accupril) 5mg, 10mg, 20mg, 40mg
Not covered Medicaid Summa Tier 3	Start 10mg QD Increase Q 2 weeks	20mg QD, 40mg QD Max 80mg QD
Not covered Medicaid Summa Tier 3	Ramipril (Altace) 1.25mg, 2.5mg, 5mg, 10mg
	Start 2.5mg QD Increase Q 2 weeks	5mg QD, 10mg QD, 15mg QD, Max 20mg QD
	Start 2.5mg QD Increase Q 2 weeks	GFR <40 Max 5mg daily
Medicaid covers Summa Tier ??	Benazepril (Lotensin) 5mg, 10mg, 20mg, 40mg
Medicaid covers Summa Tier ??	Start 10mg QD Increase Q 2 weeks	20mg QD, 40mg QD Max 80mg QD
ARB
Medicaid covers Summa Tier 3	Candesartan (Atacand) 4mg, 8mg, 16mg, 32mg
Medicaid covers Summa Tier 3	Start 8mg QD Increase Q 2 weeks	16mg QD, 24mg QD MAX 32mg QD
Not covered Medicaid Summa Tier 3	Eprosartan (Teveten) 400mg, 600mg
Not covered Medicaid Summa Tier 3	Start 400 mg QD Increase to 800mg QD in 2 weeks	Max 800 mg daily
Not covered Medicaid Summa Tier 3	Telmisartan (Micardis) 20mg, 40mg, 80mg
Not covered Medicaid Summa Tier 3	Start 20mg QD Increase Q 2 weeks	40mg QD, 60mg QD Max 80mg QD
Medicaid covers Summa Tier 2	Losartan (Cozaar) 25mg, 50mg, 100mg
Medicaid covers Summa Tier 2	Start 25mg QD Increase Q 2 weeks	50mg QD, Max 100mg QD
Not covered Medicaid Summa Tier 3	Irbesartan (Avapro) 75mg, 150mg, 300mg
	Start 75mg QD Increase Q 2 weeks	150mg QD, Max 300mg daily
	Start 75mg QD Increase Q 2 weeks	Goal DM nephropathy 300mg
Medicaid covers Summa Tier 3	Valsartan (Diovan) 40mg, 80mg, 160mg, 320mg
	Start 40mg QD Increase Q 2 weeks	80mg QD, 160mg QD, Max 320mg daily
	Start 40mg QD Increase Q 2 weeks	Goal LV dysfunction 160mg BID
Medicaid covers Summa Tier 2	Olmesartan (Benicar) 5mg, 20mg, 40mg
Medicaid covers Summa Tier 2	Start 10mg QD Increase Q 2 weeks	20mg QD, Max 40mg
Calcium Channel Blocker (CCB)
Non-dihydropyridine	Verapamil SR (Calan, Verelan, Isoptin, Covera) 120mg, 180mg, 240mg	Preferred CCB in DM
	Start 120 mg QD Increase Q 1-2 weeks Contraindicated in 2^nd or 3^rd degree AV block, Severe LV dysfunction, CHF	240mg QD, (dose >240mg may only increase side effects) 360mg QD, Max 480mg QD
	Diltiazem SR (Cardizem, Tiazac, Dilacor) 120mg, 180mg, 240mg, 300mg, 360mg, 420mg
	Start 120mg QD Increase Q 1-2 weeks	240mg QD, 360mg QD, Max 480mg QD
Dihydropyridine
Medicaid covers Summa Tier 1	Nifedipine ER (Procardia, Adalat)
Medicaid covers Summa Tier 1	Start 30mg daily Increase Q 1-2 weeks	60mg, 90mg (dose > 90mg may only increase side effects) Max 120mg
Not covered Medicaid Summa Tier 2	Amlodipine (Norvasc) 5mg, 10mg
Not covered Medicaid Summa Tier 2	Start 5mg Increase in 1-2 weeks	Max 10mg
Medicaid covers Summa Tier 2	Felodipine (Plendil) CR
Medicaid covers Summa Tier 2	Start 5mg QD Increase Q 1-2 weeks	10mg QD, 15mg QD, Max 20mg QD
Medicaid covers Summa Tier 1	Nicardipine (Cardene) 30mg, 45mg, 60mg
Medicaid covers Summa Tier 1	Start 30mg BID Increase Q 1-2 weeks	45mg BID, Max 60mg BID
Not covered Medicaid Summa Tier 3	Isradipine (DynaCirc) 5mg, 10mg	Max 20mg QD
Not covered Medicaid Summa Tier 3	Start 5mg QD Increase Q1-2 weeks	10mg, 15mg Max 20mg
Medicaid covers Summa Tier 3	Nisoldipine (Sular) 20mg, 30mg, 40mg
Medicaid covers Summa Tier 3	Start 20mg QD Increase Q1-2 weeks	40mg QD (dose >40mg may only increase side effects) Max 60mg
Beta Blockers
Medicaid covers Summa Tier 1	Atenolol (Tenormin) 25mg, 50mg, 100mg
Medicaid covers Summa Tier 1	Begin 50 mg daily Increase Q 2 weeks	100mg QD (dose above 100mg/day unlikely to lower BP) Max 2oomg QD
Medicaid covers Summa Tier 2	Carvedilol (Coreg) 3.125mg, 6.25mg, 12.5mg, 25mg
Medicaid covers Summa Tier 2	Start 3.125mg BID Increase Q 2 weeks	6.25mg BID, 12.5mg BID, Max 25mg BID
Medicaid covers Summa Tier 1	Labetalol (Normodyne, Trandate) 100mg, 200mg, 300mg	DM may require higher dose
Medicaid covers Summa Tier 1	Start 100mg BID Increase Q 2-3 weeks	200mg BID, 300mg BID, 400mg BID, etc Max 1,200mg BID
Medicaid covers Summa Tier 1	Metoprolol (Lopressor, ToprolXL) 25mg, 50mg, 100mg
Medicaid covers Summa Tier 1	Start 12.5mg (1/2 tablet) BID	25mg BID, 50mg BID, 75mg BID, 100mg BID, 150mg BID, 200mg BID Max 225mg BID

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