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vericiguat — CareFirst (Caremark)

To reduce the risk of cardiovascular death and heart failure hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics in adults with symptomatic chronic heart failure and ejection fraction <45%

Initial criteria

  • Patient age ≥ 18 years
  • Prescribed to reduce the risk of cardiovascular death and heart failure hospitalization in an adult with symptomatic chronic heart failure
  • Left ventricular ejection fraction (LVEF) < 45% (documentation required)
  • Patient is currently receiving optimal therapy for heart failure (e.g., ACE inhibitor, angiotensin II receptor blocker, angiotensin receptor-neprilysin inhibitor, beta-blocker, SGLT2 inhibitor, mineralocorticoid receptor antagonist)
  • Patient has had ANY of the following: hospitalization for heart failure within the past 6 months OR outpatient intravenous diuretics for heart failure within the past 3 months

Reauthorization criteria

  • Prescribed to reduce the risk of cardiovascular death and heart failure hospitalization in an adult with symptomatic chronic heart failure
  • Left ventricular ejection fraction (LVEF) < 45% (documentation required)
  • Patient is currently receiving optimal therapy for heart failure (e.g., ACE inhibitor, angiotensin II receptor blocker, angiotensin receptor-neprilysin inhibitor, beta-blocker, SGLT2 inhibitor, mineralocorticoid receptor antagonist)

Approval duration

12 months