Corlanor (ivabradine) oral solution — Highmark

Preferred products

• ivabradine (generic)

Initial criteria

• age ≥ 18 years
• Diagnosis of stable, symptomatic chronic heart failure (ICD-10: I50)
• In normal sinus rhythm
• Left ventricular ejection fraction (LVEF) ≤ 35%
• Resting heart rate ≥ 70 beats per minute
• Member meets one of the following: concurrently taking bisoprolol OR carvedilol OR metoprolol succinate OR has experienced therapeutic failure, contraindication, or intolerance to the maximum tolerated dose of bisoprolol, carvedilol, and metoprolol succinate
• If request is for Corlanor oral solution: inability to swallow tablets
• If request is for brand Corlanor tablets: therapeutic failure or intolerance to generic ivabradine

Reauthorization criteria

• Prescriber attests that the member has experienced positive clinical response to therapy
• If request is for Corlanor oral solution: prescriber attests that the member continues to have an inability to swallow tablets
• If request is for brand Corlanor tablets and member is at least 18 years of age: therapeutic failure or intolerance to generic ivabradine

Approval duration

12 months