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