Camzyos — Medical Mutual

Initial criteria

• Patient age ≥ 18 years; AND
• Patient has at least one symptom associated with obstructive hypertrophic cardiomyopathy; AND
• Patient has New York Heart Association Class II or III symptoms of heart failure; AND
• Patient with left ventricular hypertrophy meets one of the following: maximal left ventricular wall thickness ≥ 15 mm OR familial hypertrophic cardiomyopathy with maximal left ventricular wall thickness ≥ 13 mm; AND
• Patient has a peak left ventricular outflow tract gradient ≥ 50 mmHg (at rest or after provocation); AND
• Patient has a left ventricular ejection fraction ≥ 55%; AND
• Medication is prescribed by a cardiologist

Reauthorization criteria

• Patient has been established on therapy for at least 8 months; AND
• Patient age ≥ 18 years; AND
• Currently or prior to starting therapy, patient has or has experienced at least one symptom associated with obstructive hypertrophic cardiomyopathy; AND
• Currently or prior to starting therapy, patient is in or was 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
• Medication is prescribed by a cardiologist

Approval duration

8 months initial, 1 year reauth