Verquvo (vericiguat) — United Healthcare

Initial criteria

• Diagnosis of heart failure
• Ejection fraction is less than 45 percent
• Heart failure is classified as one of the following: New York Heart Association Class II OR New York Heart Association Class III OR New York Heart Association Class IV
• One of the following: Hospitalization for heart failure within the past 6 months OR Outpatient IV diuretics for heart failure within the past 3 months
• One of the following: Patient is on a stabilized dose and receiving concomitant therapy with a maximally tolerated beta-blocker (e.g., bisoprolol, carvedilol, metoprolol) OR Patient has a contraindication or intolerance to beta-blocker therapy
• One of the following: Patient is on a stabilized dose and receiving concomitant therapy with one of the following - angiotensin converting enzyme (ACE) inhibitor (e.g., captopril, enalapril) OR angiotensin II receptor blocker (ARB) (e.g., candesartan, valsartan) OR angiotensin receptor-neprilysin inhibitor (ARNI) (e.g., Entresto) OR Patient has an allergy, contraindication, or intolerance to ACE inhibitors, ARBs, and ARNIs
• One of the following: Patient is on a stabilized dose and receiving concomitant therapy with a maximally tolerated aldosterone antagonist (e.g., eplerenone, spironolactone) OR Patient has a contraindication or intolerance to aldosterone antagonist therapy
• One of the following: Patient is on a stabilized dose and receiving concomitant therapy with Jardiance or Farxiga (including combination products containing empagliflozin or dapagliflozin) OR Patient has a contraindication or intolerance to SGLT2 inhibitor therapy
• Verquvo is prescribed by or in consultation with a cardiologist

Reauthorization criteria

• Documentation of positive clinical response to therapy

Approval duration

12 months