Limited coverage criteria – vericiguat

Generic name

vericiguat

Strength & form

2.5 mg/5 mg/10 mg tablet

Initial

For the treatment of symptomatic chronic heart failure (HF) in adult patients 18 years of age and older with reduced ejection fraction who are stabilized after a recent decompensation event if ALL the following clinical criteria are met:

Left ventricular ejection fraction (LVEF) < 45% AND New York Heart Association (NYHA) Class II to IV

AND

The patient had a recent HF decompensation event requiring hospitalization and/or intravenous (IV) diuretic therapy¹

AND

The patient will use vericiguat as an adjunct to standard of care² therapy, which includes the following:

• An angiotensim-coverting enzyme inhibitor (ACEI) OR angiotensin receptor blocker (ARB) OR angiotensin receptor/neprilysin inhibitor (ARNI)

​AND

• A beta-blocker (BB)

AND

• A mineralocorticoid receptor antagonist (MRA)

AND

• A sodium-glucose cotransporter-2 inhibitor (SGLT2i)

Indefinite