Pharmacy Prior Authorization Criteria

Verquvo (vericiguat)

Indications for Prior Authorization

Verquvo (vericiguat)

• For diagnosis of Chronic Heart Failure
  Indicated to reduce the risk of cardiovascular death and heart failure (HF) hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics, in adults with symptomatic chronic HF and ejection fraction less than 45%.

Criteria

Verquvo

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

• Diagnosis of chronic heart failure
AND
• Patient has an ejection fraction less than 45 percent
AND
• Patient has New York Heart Association (NYHA) Class II, III, or IV symptoms
AND
• One of the following:
• Patient was hospitalized for heart failure within the last 6 months
OR
• Patient used outpatient intravenous diuretics (e.g., bumetanide, furosemide) for heart failure within the last 3 months
AND
• Trial and failure, contraindication, or intolerance to all of the following at a maximally tolerated dose: [1-4]
• One of the following:
• Angiotensin converting enzyme (ACE) inhibitor (e.g., captopril, enalapril)
• Angiotensin II receptor blocker (ARB) (e.g., candesartan, valsartan)
• Angiotensin receptor-neprilysin inhibitor (ARNI) [e.g., Entresto (sacubitril and valsartan)]
AND
• One of the following: [A, 4]
• bisoprolol
• carvedilol
• metoprolol succinate extended-release
AND
• Sodium-glucose co-transporter 2 (SGLT2) inhibitor [e.g., Jardiance (empagliflozin), Farxiga (dapagliflozin), Xigduo XR (dapagliflozin and metformn)]
AND
• Mineralocorticoid receptor antagonist (MRA) [e.g., eplerenone, spironolactone]
AND
• Prescribed by or in consultation with a cardiologist

Verquvo

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

• Patient demonstrates positive clinical response to therapy

P & T Revisions

2024-03-07, 2023-10-17, 2023-03-16, 2022-08-18, 2022-03-03, 2021-03-03

References

1. Verquvo Prescribing Information. Merck & Co., Inc. Whitehouse Station, NJ. July 2023.
2. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):e240-327.
3. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2017 Aug;23(8):628-651.
4. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Journal of Cardiac Failure. Published online April 2022.

---

End Notes

1. Per 2022 AHA/ACC/HFSA guideline for the management of Heart Failure, three beta blockers have been shown to be effective in reducing the risk of death in patients with HFrEF: bisoprolol, metoprolol succinate, and carvedilol. [4]

---

Revision History

• 2024-03-07: 2024 Annual Review. No criteria changes. Background updates.
• 2023-10-17: Program update to standard reauthorization language. No changes to clinical intent.
• 2023-03-16: Annual review, no changes to criteria
• 2022-08-18: Addition of SGLT2 inhibitor and MRA as step requirements
• 2022-03-03: Annual review: Background updates.
• 2021-03-03: New program

---