Camzyos (mavacamten) — Highmark
symptomatic obstructive hypertrophic cardiomyopathy (HCM) classified as NYHA class II or III
Preferred products
- non-vasodilating beta blocker
- non-dihydropyridine calcium channel blocker
Initial criteria
- age ≥ 18 years
- prescribed by or in consultation with a cardiologist or physician who specializes in the treatment of hypertrophic cardiomyopathy (HCM)
- diagnosis of symptomatic obstructive HCM (ICD-10: I42.1)
- LVEF ≥ 55%
- Valsalva LVOT peak gradient ≥ 50 mm Hg at rest or after provocation
- symptomatology classified as NYHA class II or III
- therapeutic failure or intolerance to one (1) of the following plan-preferred medications, or all are contraindicated: non-vasodilating beta blocker (e.g., metoprolol, propranolol, atenolol) OR non-dihydropyridine calcium channel blocker (e.g., verapamil, diltiazem)
- not currently treated with nor will be treated with disopyramide, ranolazine, or a combination of beta blockers and calcium channel blockers
Reauthorization criteria
- prescriber attests that the member has experienced a positive clinical response to therapy defined as meeting one (1) of the following: reduction in NYHA class OR no NYHA class worsening
- not currently treated with nor will be treated with disopyramide, ranolazine, or a combination of beta blockers and calcium channel blockers
Approval duration
12 months