Corlanor (ivabradine) coverage and prior authorization policy
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Governs coverage, prior authorization requirements, dosing, and quantity limits for Corlanor (ivabradine) for Blue Cross Blue Shield - Iowa members; applies where the benefit exists and member-specific contract terms allow.
No material clinical or coverage changes in this revision.
Coverage Criteria and Indications
Adult chronic HFrEF criteria
Authorization may be granted when ALL of the following criteria are met:
ALL of the following
- Requested drug is being prescribed for an adult (≥18 years)
- Left ventricular ejection fraction (LVEF) ≤ 35%
- Member is currently receiving guideline‑directed/optimal therapy for heart failure management (examples include ACEI, ARB, ARNI, beta‑blocker, SGLT2 inhibitor, MRA)
ONE of the following
- Member is receiving a maximally tolerated dose of a beta‑blocker
- Member has intolerance or contraindication to beta‑blocker use
- Member is in sinus rhythm
ALL of the following
- Authorization may be granted when all criteria are met; otherwise therapy is not medically necessary
Pediatric DCM criteria
Authorization may be granted when ALL of the following criteria are met:
ALL of the following
- Requested drug is being prescribed for a pediatric member 6 months of age or older
- Member is in sinus rhythm
- Member has an elevated heart rate (per pediatric labeling)
ALL of the following
- Authorization may be granted when all criteria are met
Inappropriate Sinus Tachycardia criteria
Authorization may be granted when the following criterion is met:
ALL of the following
- Requested drug is being prescribed for an adult (≥18 years)
- Use is for management of symptomatic inappropriate sinus tachycardia (IST) consistent with compendial support and guideline permissiveness
- Approval duration: 12 months when criteria are met
ALL of the following
- Authorization may be granted for 12 months when criteria are met
Coverage criteria for ivabradine
Coverage includes adults and pediatric patients; dosing and clinical requirements summarized below.
ALL of the following
- Start 5 mg PO twice daily with food
- Assess after 2 weeks and adjust dose to achieve resting heart rate 50–60 BPM
- Adjust thereafter based on resting heart rate and tolerability; maximum 7.5 mg twice daily
- Initial approval requires resting heart rate ≥ 70 BPM for adult patients
ALL of the following
- Oral solution start 0.05 mg/kg PO twice daily with food
- Assess every 2 weeks and increase by 0.05 mg/kg to target ≥20% heart rate reduction based on tolerability
- Maximum dose: 0.2 mg/kg twice daily for patients 6 months to <1 year; 0.3 mg/kg twice daily for patients ≥1 year (up to total 7.5 mg twice daily)
- Initial approval requires an elevated heart rate in pediatric patients
ALL of the following
- Tablets start 2.5 mg PO twice daily with food
- Assess every 2 weeks and adjust by 2.5 mg to target ≥20% heart rate reduction based on tolerability
- Maximum 7.5 mg twice daily
ALL of the following
- Ivabradine may be used for symptomatic IST as reasonable ongoing management per ACC/AHA/HRS guidance
- Report provider services with appropriate CPT/HCPCS/revenue/ICD codes
Dosing and Monitoring for Initial Therapy
Dosing and monitoring
Starting doses and monitoring requirements as per labeling:
ALL of the following
- Start 5 mg PO twice daily with food
- Assess patient after 2 weeks and adjust dose to achieve resting HR 50–60 BPM
- Adjust thereafter based on resting HR and tolerability; maximum 7.5 mg twice daily
ALL of the following
- Start oral solution 0.05 mg/kg PO twice daily with food
- Assess at 2‑week intervals and adjust by 0.05 mg/kg to target ≥20% HR reduction based on tolerability
- Maximum 0.2 mg/kg twice daily for 6 months to <1 year; 0.3 mg/kg twice daily for ≥1 year (up to 7.5 mg twice daily)
ALL of the following
- Start tablets 2.5 mg PO twice daily with food
- Assess at 2‑week intervals and adjust by 2.5 mg to target ≥20% HR reduction based on tolerability
- Maximum 7.5 mg twice daily
ALL of the following
- Initial approval requires resting heart rate ≥70 BPM for adults or elevated heart rate for pediatric patients
Initial therapy dosing and monitoring requirements (operational)
Initial dosing and monitoring operational steps for initiation:
ALL of the following
- Begin ivabradine 5 mg PO twice daily with food
- Reassess at 2 weeks to evaluate resting heart rate and tolerability
- Adjust dose (increase or decrease) to achieve target resting HR 50–60 BPM; do not exceed 7.5 mg twice daily
ALL of the following
- Begin oral solution 0.05 mg/kg PO twice daily with food
- Reassess every 2 weeks and adjust by 0.05 mg/kg to reach ≥20% HR reduction while monitoring tolerability
- Observe age‑based maximums per labeling (0.2 mg/kg twice daily for 6 months to <1 year; 0.3 mg/kg twice daily for ≥1 year) up to 7.5 mg twice daily
ALL of the following
- Begin tablets 2.5 mg PO twice daily with food
- Reassess every 2 weeks and adjust by 2.5 mg to reach ≥20% HR reduction while monitoring tolerability
- Do not exceed 7.5 mg twice daily
Initial resting heart rate requirement (≥70 BPM in adults; elevated HR in pediatrics) is required only for initial approval per labeling and policy; ongoing monitoring and dose adjustments should follow the reassessment schedule above.
Coding and Quantity Limits
| No codes listed |
Product-Specific Quantity Limits
Provider Requirements and Prior Authorization
Required documentation: LVEF chart notes
Submit chart notes or medical records documenting left ventricular ejection fraction (LVEF) with the prior authorization request to initiate review.
- Provide documentation of LVEF measurement (chart notes or medical records).
Prior authorization criteria: meet all indication‑specific criteria
Prior authorization is required and varies by indication; authorization will be granted only when all criteria listed for the specific indication (adult chronic HFrEF, pediatric DCM, or adult IST) are met.
- Adult chronic HFrEF: all criteria in the Chronic Heart Failure section must be met.
- Pediatric DCM: all criteria in the Heart Failure Due to Dilated Cardiomyopathy section must be met.
- IST (adult): the Inappropriate Sinus Tachycardia criteria must be met; approval duration noted in that section.
Denial risk: not medically necessary if criteria unmet
If the member does not meet the listed authorization criteria for the requested indication, Corlanor (ivabradine) is considered not medically necessary and the request may be denied.
Initial approval and dosing assessment: heart rate targets and 2‑week reassessment
Initial approval requires evidence of the indicated heart‑rate threshold and monitoring: adults must have a resting heart rate ≥ 70 BPM for initial approval; pediatric patients must have an elevated heart rate per labeling. Dose assessment is required at two‑week intervals with adjustments to achieve target heart‑rate reduction (adults target 50–60 BPM; pediatrics target ≥20% reduction).
- Adults: start 5 mg PO twice daily with food; reassess at 2 weeks and adjust to target resting HR 50–60 BPM; max 7.5 mg twice daily.
- Pediatrics (<40 kg): oral solution start 0.05 mg/kg twice daily with food; reassess every 2 weeks and adjust by 0.05 mg/kg to target ≥20% HR reduction; age‑based maximum dosing applies.
- Pediatrics (>40 kg): tablets start 2.5 mg twice daily with food; reassess every 2 weeks and adjust by 2.5 mg to target ≥20% HR reduction; max 7.5 mg twice daily.
Billing and coding: use appropriate CPT/HCPCS/revenue/ICD codes and observe quantity limits
When reporting provider services related to the authorization or management of Corlanor (ivabradine), report services using the appropriate CPT, HCPCS (alpha‑numeric), revenue, and ICD diagnostic codes.
- Adhere to quantity limits when billing: Corlanor oral solution — 450 mL per 30 days; Corlanor tablets — 2 tablets per day.
Key Definitions
Policy Revision History
Policy reviewed and effective date set; document last review and effective date recorded as June 3, 2026.
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