Entresto (valsartan-sacubitril) — United Healthcare

Heart failure

Initial criteria

As continuation of therapy initiated during an inpatient stay OR
Diagnosis of pediatric heart failure with systemic left ventricular systolic dysfunction which is symptomatic AND prescribed by or in consultation with a cardiologist OR
Diagnosis of heart failure (with or without hypertension) AND
Ejection fraction ≤ 40 percent OR (Ejection fraction > 40 percent AND patient has structural heart disease [left atrial enlargement or left ventricular hypertrophy]) AND
Heart failure is classified as New York Heart Association Class II OR Class III OR Class IV AND
Patient does not have a history of angioedema AND
Patient will discontinue any use of concomitant ACE Inhibitor or ARB before initiating treatment with Entresto; ACE inhibitors must be discontinued at least 36 hours prior to initiation AND
Patient is not concomitantly on aliskiren therapy AND
Prescription is by or in consultation with a cardiologist

Entresto dose has been titrated to 97 mg/103 mg twice daily or to the maximum labeled dose for pediatric patients, or to a maximum dose as tolerated by the patient AND
Documentation of positive clinical response to therapy

12 months