New High Blood Pressure Drugs Highlight the Importance of Connected Pharmacy, Medical, and Dental Care
Read the full July formulary update.
High blood pressure is a common and sometimes costly chronic condition. For many people, blood pressure can be managed with lifestyle changes and commonly used medications. But for others, blood pressure remains above goal even after taking multiple medications. This is called resistant hypertension. Members with resistant hypertension may be at higher risk for serious cardiovascular events and kidney disease. They may also have other chronic conditions such as diabetes, obesity, or cardiovascular disease, which can make care more complex.
Recent drug pipeline activity is bringing new attention to resistant hypertension. Newer therapies are being developed to target aldosterone, a hormone that can contribute to fluid retention, sodium retention, and elevated blood pressure. For employers, this is also an opportunity to think about cardiovascular health more broadly. Pharmacy benefits, medical management, and preventive dental care can work together to support members with chronic conditions and help address health risks earlier.
What is resistant hypertension?
Resistant hypertension generally refers to blood pressure that remains above goal despite treatment with three or more blood pressure medications at the same time. These members may already be taking multiple drugs, including what is known as a diuretic, and may still need additional support to lower their blood pressure to at or below goal to reduce their cardiovascular risk. This can create challenges for members, providers, and employers:
- Members may face a more complex medication regimen.
- Providers may need to evaluate adherence, lifestyle factors, medication interactions, and underlying conditions.
- Employers may see higher costs as time goes on if resistant hypertension is not resolved from emergency visits, hospitalizations, heart failure, stroke, kidney disease, and other complications.
New treatments are emerging
A new class of medications, called aldosterone synthase inhibitors or ASIs, is receiving increased attention. These drugs are designed to reduce production of aldosterone, a hormone involved in blood pressure regulation. Baxfendy (baxdrostat) is a newly approved drug for adults with hypertension whose blood pressure is not adequately controlled on other agents and is meant to be used in combination with other antihypertensive drugs. Other ASIs, including lorundrostat and vicadrostat, are also being studied for resistant hypertension and related cardio-kidney conditions. These therapies may provide new options for certain members, but they will also require a careful review to assess their clinical effectiveness, safety, and value.
As with all new drugs, Premera will continue to evaluate these new medications through our established evidence-based review process. This includes reviewing:
- Strength and quality of clinical evidence
- Comparative effectiveness
- Safety considerations
- Appropriate use
- Cost and overall value
- Available lower-cost alternatives
The goal is to support access to medically necessary care while helping employer groups manage their pharmacy trend responsibly.
Generic dapagliflozin is now available
A generic version of Farxiga, called dapagliflozin, is now available. SGLT2 inhibitor medications are commonly used across several cardio-kidney-metabolic conditions, including type 2 diabetes and heart failure. For some members, generic dapagliflozin may offer a more affordable option, depending on their condition, benefit design, and current medication(s). Members who take Farxiga should talk with their provider or pharmacist about whether switching to generic dapagliflozin is clinically appropriate.
Why this matters now
Cardiovascular, kidney, and metabolic conditions are increasingly being treated as connected conditions rather than separate diseases. For employers, this means future cost and care strategies will need to look across benefit lines. A member with resistant hypertension may also have diabetes, kidney disease, heart failure risk, or more oral health needs. Managing those risks separately can create gaps in care. A connected strategy can identify those gaps earlier.
Dental care is part of the whole-person health story
Dental care may not be the first thing that comes to mind when you think about high blood pressure. But oral health is closely connected to overall health, especially for members with chronic conditions. Periodontal disease has been associated with conditions such as cardiovascular disease and diabetes. The relationship is complex, however oral inflammation, gum disease, and delayed preventive dental care can affect a member’s overall health.
Oral health matters for members with chronic conditions, including:
- Cardiovascular disease
- Diabetes and gestational diabetes
- Chronic obstructive pulmonary disease
- Oral cancer
Members with these conditions may benefit from more consistent dental engagement, preventive cleanings, periodontal maintenance, and education about the connection between oral health and overall health. For employers, dental benefits can do more than support oral health. When connected with medical and pharmacy data, dental benefits can become part of a broader strategy to improve engagement, reduce avoidable complications, and support total cost of care.
Enhanced Dental Care supports high-risk members
Premera’s Enhance Dental Care benefit is designed to help eligible members with certain chronic conditions receive additional dental support. For eligible large groups that include dental benefits, the benefit can provide additional covered dental services for members with qualifying chronic conditions. These may include services such as:
- Oral evaluations
- Additional cleanings or periodontal maintenance
- Topical fluoride
- Periodontal scaling and root planing
- Full mouth debridement
The value of Enhanced Dental Care is not only the additional dental coverage, but also the Medical-Dental integration. Having both medical and Enhanced Dental Care benefits with Premera connects medical and dental information to support more coordinated, whole-person care. Premera’s integrated approach helps close that gap by using medical and dental data to support education, engagement, and care coordination. This can help:
- Identify members with chronic conditions who may benefit from additional dental support.
- Give care managers more complete information when working with members.
- Support targeted outreach to members who have not seen a dentist.
- Reinforce the role of preventive dental care in whole-person health.
- Give employers better visibility into engagement and dental benefit utilization over time.
The goal is to reduce barriers to preventive dental care for members whose medical conditions may put them at higher risk. A member may be actively managing medications through the pharmacy benefit and seeing medical providers for chronic condition management, but still not using preventive dental care. Enhanced Dental Care helps create another pathway to engage those members and provide them with additional oral health support.
Looking Ahead
The hypertension treatment landscape is continuing to evolve with new therapies in development for members whose blood pressure remains difficult to control. Resistant hypertension highlights the importance of looking at cardiovascular risk more broadly. Pharmacy benefits, medical care, and the right preventive dental care can all help members manage chronic conditions and reduce future health risks.