Corlanor (ivabradine) oral solution — Highmark
Symptomatic heart failure due to dilated cardiomyopathy in pediatrics
Initial criteria
- Age 6 months to 17 years
- Diagnosis of stable symptomatic heart failure (ICD-10: I50) due to dilated cardiomyopathy
- In normal sinus rhythm
- Resting heart rate ≥ 70 beats per minute
- If request is for Corlanor oral solution: inability to swallow tablets
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 symptomatic heart failure due to dilated cardiomyopathy: member is 6 months to 17 years of age
Approval duration
12 months