Medicaid coverage for fixed-dose combination antihypertensive medications – fifty states and Washington, D.C., 2022

Nearly 93 million adults in the United States (US) have uncontrolled hypertension, a leading risk factor for heart disease and stroke. Increasing the use of fixed-dose combination antihypertensives (FDCs) has been proposed as a strategy to improve hypertension control. Using publicly available 2022 coverage information from 282 state Medicaid fee-for-service and managed care plans, we assessed coverage of FDCs in the 50 US states and Washington, D.C. No FDC had preferred coverage status in all plans. Losartan/hydrochlorothiazide had preferred status in 99.3% of plans. At least two FDCs—containing an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus a thiazide diuretic, and an ACEI or ARB plus a calcium channel blocker—had preferred status in 100 and 80.1% of plans, respectively. At least one triple combination FDC was preferred in nearly half (49.6%) of plans. Comprehensive coverage was limited. To enhance hypertension control, State Medicaid plans may consider approaches to remove barriers to accessing FDCs.