Camzyos (mavacamten) — CareFirst (Caremark)
Symptomatic New York Heart Association (NYHA) class II–III obstructive hypertrophic cardiomyopathy
Preferred products
- atenolol
- metoprolol
- diltiazem
- verapamil
Initial criteria
- Member has left ventricular wall thickness ≥ 15 mm anywhere in the left ventricle OR ≥ 13 mm in members with familial hypertrophic cardiomyopathy or a positive genetic test (e.g., MYH7, MYBPC3, TNNI3, TNNT2, TPM1, MYL2, MYL3, ACTC1 gene variants)
- Member has NYHA functional class II to class III symptoms
- Baseline left ventricular ejection fraction (LVEF) ≥ 55%
- Baseline Valsalva left ventricular outflow tract (LVOT) peak gradient ≥ 50 mmHg
- Member has experienced an inadequate response to a beta-adrenergic antagonist (e.g., atenolol, metoprolol) or a non-dihydropyridine calcium channel blocker (diltiazem, verapamil) at maximally tolerated dose, OR has an intolerance or contraindication to both therapies
Reauthorization criteria
- Member has achieved or maintained a positive clinical response to therapy (e.g., increase in peak oxygen consumption [pVO2], NYHA class reduction)
- Left ventricular ejection fraction (LVEF) ≥ 50%
Approval duration
Initial: 3 months; Reauthorization: 12 months