Verquvo (vericiguat) — Highmark

heart failure with NYHA class II, III, or IV and left ventricular ejection fraction < 45%

Initial criteria

Diagnosis of heart failure (ICD-10: I50)
Heart failure classified as NYHA class II, III, or IV
Left ventricular ejection fraction (LVEF) less than 45%
Verquvo is used in combination with one of the following antihypertensives, or all are contraindicated: ACE inhibitor, ARB, or Entresto (sacubitril/valsartan)
Verquvo is used in combination with one of the following beta-blockers, or all are contraindicated: bisoprolol, carvedilol (immediate-release or extended-release), or metoprolol succinate extended-release
Member has been hospitalized for heart failure in the past 6 months OR received outpatient IV diuretics for heart failure in the past 3 months

Prescriber attests that the member has experienced positive clinical response to therapy

12 months