ivabradine — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for an adult patient
• The patient has left ventricular ejection fraction ≤ 35%
• Documentation is required for approval
• The patient is currently receiving optimal therapy for heart failure management (e.g., ACEI, ARB, ARNI, beta‑blocker, SGLT2I, MRA)
• The patient meets ONE of the following: (a) receiving treatment with maximally tolerated dose of beta‑blocker OR (b) intolerance or contraindication to beta‑blocker use
• The patient is in sinus rhythm
• The patient has resting heart rate ≥ 70 beats per minute

Reauthorization criteria

• The requested drug is being prescribed for an adult patient
• The patient has left ventricular ejection fraction ≤ 35%
• Documentation is required for approval
• The patient is currently receiving optimal therapy for heart failure management (e.g., ACEI, ARB, ARNI, beta‑blocker, SGLT2I, MRA)
• The patient meets ONE of the following: (a) receiving treatment with maximally tolerated dose of beta‑blocker OR (b) intolerance or contraindication to beta‑blocker use
• The patient is in sinus rhythm

Approval duration

12 months