Limited Use Note(s)

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VERICIGUAT2.5mg Tab
Reason For Use CodeClinical Criteria
685For the treatment of symptomatic chronic heart failure (HF) as an adjunct to standard-of-care therapy in adult patients with reduced ejection fraction who are stabilized after a recent HF decompensation event, if all the following conditions are met: (a) Left ventricular ejection fraction (LVEF) less than 45%; (b) New York Heart Association (NYHA) class II to IV symptoms; (c) HF decompensation event requiring hospitalization within the previous 6 months and/or intravenous diuretic treatment for HF (without hospitalization) within the previous 3 months; (d) Vericiquat is used in combination with standard-of-care* HF therapy; and (e) Initiated under the supervision of a prescriber who is experienced in the management of HF. * Standard-of-care HF therapy includes one medication from each of the following categories, unless there is a contraindication or intolerance: (a) angiotensin receptor-neprilysin inhibitor (ARNI) or angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB); (b) beta blocker; (c) mineralocorticoid receptor antagonist (MRA); and (d) sodium-glucose cotransporter-2 (SGLT2) inhibitor
LU Authorization Period: Indefinite