Camzyos (mavacamten) — United Healthcare

Initial criteria

• Diagnosis of obstructive hypertrophic cardiomyopathy (HCM)
• Heart failure classified as New York Heart Association (NYHA) class II OR class III
• Left ventricular ejection fraction ≥ 55%
• Valsalva left ventricular outflow tract (LVOT) peak gradient ≥ 50 mmHg at rest or with provocation
• History of inadequate response, intolerance, failure, or contraindication to two of the following at a maximally tolerated dose: (1) Non-vasodilating beta blocker (e.g., atenolol, bisoprolol, metoprolol, nadolol, propranolol) (2) Nondihydropyridine calcium channel blocker (i.e., diltiazem, verapamil) (3) Disopyramide
• Prescribed by or in consultation with a cardiologist

Reauthorization criteria

• Documentation of positive clinical response to therapy as supported by: Reduction in NYHA class OR No worsening in NYHA class
• Left ventricular ejection fraction ≥ 50%
• Prescribed by or in consultation with a cardiologist

Approval duration

12 months