Camzyos (mavacamten capsules - MyoKardia/Bristol Myers Squibb) — Cigna

Initial criteria

• Patient has a diagnosis of obstructive hypertrophic cardiomyopathy; AND
• Patient is in or was in New York Heart Association Class II or III heart failure; AND
• Patient has a left ventricular ejection fraction ≥ 50%; AND
• The medication is prescribed by a cardiologist

Reauthorization criteria

• Patient is currently or was previously in New York Heart Association Class II or III heart failure; AND
• Patient has a current left ventricular ejection fraction ≥ 50%; AND
• Patient experienced a beneficial clinical response when assessed by at least one objective measure OR patient experienced stabilization or improvement in at least one symptom related to obstructive hypertrophic cardiomyopathy; AND
• The medication is prescribed by a cardiologist

Approval duration

12 months