Right. Many of them will reimburse for an ARB only after a patient tries—and fails—to reach goal on an ACE. Good luck to anyone who wants to get reimbursed for taking both together.
ACE’s are very cheap on a self-pay basis; however, I’ve run into situations where insurers balk at reimbursing for drug A because a patient is taking drug B on a self-pay basis! The insurers apparently find out about this via the PBM’s database, so it may help to procure the self-pay drug from a different pharmacy.