Product Details
Verquvo
Vericiguat5 mg
Tablet
DIN/PIN/NPN
02537052
Manufacturer
Bayer Inc., Health Care Division
Formulary Listing Date
2024-09-27
Unit Price
4.8300
Amount MOH Pays
4.8300
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C01DX22
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
685 | Indefinite | For 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 |