Ranexa (ranolazine extended-release) — CareFirst (Caremark)
Chronic angina
Preferred products
- beta blocker
- calcium channel blocker
- long-acting nitrate
Initial criteria
- The patient has experienced an inadequate treatment response to a combination of TWO of the following: beta blocker, calcium channel blocker, long-acting nitrate.
- OR The patient has experienced an intolerance to a combination of TWO of the following: beta blocker, calcium channel blocker, long-acting nitrate.
- OR The patient has a contraindication to a combination of TWO of the following: beta blocker, calcium channel blocker, long-acting nitrate.
Reauthorization criteria
- The patient has achieved or maintained a positive clinical response to treatment from baseline.
Approval duration
Initial therapy 12 months; Continuation 36 months