Limited Use Note(s)

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Reason For Use CodeClinical Criteria
For patients with:
183a) NYHA Class II or III Congestive Heart Failure (CHF); and b) Currently being treated with an angiotensin converting enzyme (ACE) inhibitor, diuretics with or without digoxin, or previously treated, and failed these agents; and c) An ejection fraction less than or equal to 35%; and d) At least one episode of symptomatic CHF within a 12 month period while receiving optimal management.
LU Authorization Period: Indefinite.