CurrentCignaPolicy N/A

Cardiology - Verquvo Drug Quantity Management Policy - Per Rx

Defines per-prescription maximum quantity limits and one-time override rules for Verquvo (vericiguat) 2.5 mg, 5 mg, and 10 mg tablets for Cigna-administered health benefit plans; includes duration of approvals and outpatient/home delivery distinctions.

Policy Summary

PayerCigna

PolicyCardiology - Verquvo Drug Quantity Management Policy - Per Rx

Policy CodePolicy N/A

Change TypeRevised (quantity limits, overrides)

Effective Date

Next Review Date

Key ActionEnsure requested Verquvo quantity per Rx does not exceed retail (30) or home delivery (90) maximums; request a one-time 30-day override for dose escalation when appropriate and document dose increase.

POLICY UPDATE CHANGES

Policy was updated to reflect existing quantity limits when product is obtained via home delivery.

Policy Statement clarified that one-time overrides are provided for 30 days in duration.

Override criteria for Verquvo 2.5 mg and 5 mg updated to approve 60 tablets at retail or 180 tablets at home delivery for dose escalation.

Annual revision and review dates recorded (2023, 2024, 2025).

3Strengths covered

30Retail max tablets per Rx

90Home delivery max tablets per Rx

60/180

One-time override qty (retail/home)

Coverage Summary

Verquvo (vericiguat) is indicated to reduce the risk of cardiovascular death and heart failure hospitalization following hospitalization for heart failure or need for outpatient intravenous diuretics in adults with symptomatic chronic heart failure and ejection fraction <45%. Dosing starts at 2.5 mg once daily with titration as tolerated to a target maintenance dose of 10 mg once daily. Per the policy, Verquvo products are covered with criteria under Drug Quantity Management rules; one-time overrides are available for dose escalation scenarios and are provided for 30 days.

General Policy Statement

Verquvo products are covered as medically necessary when Drug Quantity Management rules are met; exceptions evaluated per criteria. One-time overrides are 30 days in duration.

ALL of the following

Requested Verquvo product must not exceed the applicable maximum quantity per Rx at point of service
If Drug Quantity Management rule not met, coverage determined by the specific product criteria below
Approvals are provided for the duration noted; one-time overrides are 30 days in duration30 days
One-time override duration

Verquvo 2.5 mg — One-time override for dose increase

Verquvo 2.5 mg tablets - One-time override for dose increase

Covered when ALL of the following are met:

ALL of the following

Dose escalation
- Retail one-time override: Retail: 60 tablets (one-time override)60 tablets
  one-time override retail quantity
- Home delivery one-time override: Home Delivery: 180 tablets (one-time override)180 tablets
  one-time override home delivery quantity

Verquvo 5 mg — One-time override for dose increase

Verquvo 5 mg tablets - One-time override for dose increase

Covered when ALL of the following are met:

ALL of the following

Dose escalation
- Retail one-time override: Retail: 60 tablets (one-time override)60 tablets
  one-time override retail quantity
- Home delivery one-time override: Home Delivery: 180 tablets (one-time override)180 tablets
  one-time override home delivery quantity

Verquvo 10 mg — Override guidance

Verquvo 10 mg tablets

Coverage/override rules:

No one-time overrides recommended for 10 mg tablets

Drug Quantity Limits (per Rx maximums)

Per strength and dispensing channel:

Per product/channel limits

2.5 mg retail: Verquvo 2.5 mg tablets — Retail Maximum Quantity per Rx = 30 tablets30 tablets
retail per-Rx maximum
2.5 mg home delivery: Verquvo 2.5 mg tablets — Home Delivery Maximum Quantity per Rx = 90 tablets90 tablets
home delivery per-Rx maximum
5 mg retail:

Provider Actions

Prior Authorization

Quantity limit enforcement at point of service

Ensure the requested Verquvo quantity per prescription does not exceed the per‑Rx maximums enforced at point of service: retail maximum = 30 tablets; home delivery maximum = 90 tablets. If the requested quantity exceeds these limits for a dose-escalation scenario, the request may be processed under the one-time override policy (overrides are limited to 30 days).

Documentation Required

Dose escalation justification for override

Document that the patient is increasing dose from 2.5 mg to 5 mg or from 5 mg to 10 mg once daily to support a one-time override request for the specified quantities (retail and home delivery override rules apply).

Applicable Codes

NDCNDC

No codes listed

HCPCS/CPT/ICD-10mixed

No codes listed

Background

Verquvo is indicated to reduce the risk of cardiovascular death and heart failure hospitalization following a hospitalization for heart failure or need for outpatient intravenous diuretics in adults with symptomatic chronic heart failure and ejection fraction <45%. The recommended starting dose is 2.5 mg orally once daily with food; the dose should be doubled approximately every 2 weeks as tolerated up to a target maintenance dose of 10 mg once daily. Refer to the prescribing information (Merck Verquvo tablets prescribing information, May 2023) for full prescribing details.

One-time override: Temporary approval provided for 30 days to allow quantities above standard per-Rx limits for dose escalation scenarios.

Home Delivery: Channel of dispensing with higher per-Rx maximum quantities (90 tablets) compared to retail.

Clinical Evidence

Evidence: Prescribing information — Merck Verquvo tablets prescribing information, May 2023.

The brief does not provide additional trial metrics or section-specific quantitative efficacy metrics beyond the referenced prescribing information and policy statistics.

Revision History

04/06/2023annual_review

Annual revision recorded; policy updated to reflect existing quantity limits when product is obtained via home delivery; no criteria changes at that time.

04/22/2024annual_review

Annual revision recorded; no criteria changes.

04/09/2025revisedLatest

Policy Statement clarified that one-time overrides are provided for 30 days in duration; override criteria for Verquvo 2.5 mg and 5 mg updated to approve 60 tablets at retail or 180 tablets at home delivery for dose escalation; no overrides recommended for 10 mg tablets.

Policy Summary

PayerCigna

PolicyCardiology - Verquvo Drug Quantity Management Policy - Per Rx

Policy CodePolicy N/A

Change TypeRevised (quantity limits, overrides)

Effective Date

Next Review Date

On This Page

Verquvo - Surface thresholds (dose escalation)

One-time override duration30 days

Override qty - Retail (dose escalation)60 tablets

Override qty - Home Delivery (dose escalation)180 tablets

Retail max per Rx (all strengths)30 tablets

Home Delivery max per Rx (all strengths)90 tablets

Verquvo - Surface thresholds (dose escalation)

One-time override duration30 days

Override qty - Retail (dose escalation)60 tablets

Override qty - Home Delivery (dose escalation)180 tablets

Retail max per Rx (all strengths)30 tablets

Home Delivery max per Rx (all strengths)90 tablets

Verquvo 5 mg tablets — Retail Maximum Quantity per Rx = 30 tablets

retail per-Rx maximum

5 mg home delivery: Verquvo 5 mg tablets — Home Delivery Maximum Quantity per Rx = 90 tablets90 tablets

home delivery per-Rx maximum

10 mg retail: Verquvo 10 mg tablets — Retail Maximum Quantity per Rx = 30 tablets30 tablets

retail per-Rx maximum

10 mg home delivery: Verquvo 10 mg tablets — Home Delivery Maximum Quantity per Rx = 90 tablets90 tablets

home delivery per-Rx maximum

Key thresholds (compact)

Retail max per Rx30 tablets

Home Delivery max per Rx90 tablets

One-time override duration30 days

Override qty - Retail60 tablets

Override qty - Home Delivery180 tablets

Billing Rule

Use appropriate dispensing channel

When submitting billing or claims information, confirm the correct dispensing channel (retail vs home delivery). Allowed per‑Rx quantities differ by channel (retail maximum 30 tablets; home delivery maximum 90 tablets), and override quantities differ accordingly (retail 60 tablets; home delivery 180 tablets for dose escalation).

revisedLatest

Clarified home delivery maximum quantities per Rx (home delivery maximum = 90 tablets vs retail maximum = 30 tablets) to reflect existing limits when product is obtained via home delivery.