CurrentCignaPolicy IP0286

Cardiology - Ivabradine

Cigna coverage policy for ivabradine (Corlanor and generic) describing prior authorization, clinical criteria for approval, who may prescribe, and not medically necessary uses. Applies to members of Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeTitle changegeneric addedclinical criteria revised

Effective DateThe policy effective date is in force until updated or retired.

Next Review Date

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist; approvals provided for 1 year when clinical criteria are met.

SourceLink

POLICY UPDATE CHANGES

Policy title changed from 'Ivabradine' to 'Cardiology - Ivabradine' and generic ivabradine tablets were added to the policy.

For adult heart failure criterion, LVEF LVEF changed from referencing 'Corlanor' to 'ivabradine'.

Added requirement that medication be prescribed by or in consultation with a cardiologist for adult and pediatric heart failure indications.

Removed multiple pediatric LVEF and resting heart rate specific criteria for dilated cardiomyopathy indication.

Added preferred product table for Employer Plans (bioequivalent generic trial and exception for formulation-related allergy).

3Indications with approval criteria

1 yearTypical approval duration

Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeTitle changegeneric addedclinical criteria revised

Effective DateThe policy effective date is in force until updated or retired.

Next Review Date

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist; approvals provided for 1 year when clinical criteria are met.

SourceLink

On This Page

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Coverage Criteria for Ivabradine

Initial Therapy - Adult Heart Failure

Approve for 1 year if the patient meets ALL of the following (A, B, C, D, E, and F):

Adult Heart Failure Approval Criteria: A) Patient is ≥ 18 years of age;

Adult Heart Failure Approval Criteria: B) Patient has a left ventricular ejection fraction (LVEF) ≤ 35% currently or prior to initiation of ivabradine therapy;≤ 35%

Adult Heart Failure Approval Criteria: C) Patient is in normal sinus rhythm or sinus tachycardia with a resting heart rate of ≥ 70 beats per minute;≥ 70 bpm

Adult Heart Failure Approval Criteria

ONE of: i. Patient has tried or is currently receiving one beta blocker for heart failure treatment;
Examples: metoprolol succinate sustained-release, carvedilol, bisoprolol, Coreg CR (carvedilol ER).
OR: ii. Patient has a contraindication to use of beta blocker therapy;
Examples of contraindications: bronchospastic disease such as COPD or asthma, severe hypotension, or bradycardia.

Adult Heart Failure Approval Criteria: E) The medication is prescribed by or in consultation with a cardiologist;

Adult Heart Failure Approval Criteria: F) Preferred product criteria is met for the product(s) as listed in the below table(s).

For Employer Plans a trial of bioequivalent generic prior to brand may be required per policy.

Initial Therapy - Pediatric Dilated Cardiomyopathy

Approve for 1 year if the patient meets BOTH of the following (A, B, and C):

Pediatric DCM Approval Criteria: A) Patient is < 18 years of age;

Pediatric DCM Approval Criteria: B) Medication is prescribed by or in consultation with a cardiologist;

Pediatric DCM Approval Criteria: C) Preferred product criteria is met for the product(s) as listed in the below table(s).

Previously included pediatric LVEF and age-specific heart rate criteria were removed per revision.

Initial Therapy - Inappropriate Sinus Tachycardia

Approve for 1 year if the patient meets BOTH of the following (A, B, and C):

Inappropriate Sinus Tachycardia Approval Criteria

ONE of: i. Patient has tried or is currently receiving one beta blocker for inappropriate sinus tachycardia;
Examples: metoprolol, bisoprolol.
OR: ii. Patient has a contraindication to use of beta blocker therapy;
Examples of contraindications: bronchospastic disease such as COPD or asthma, severe hypotension, or bradycardia.

Inappropriate Sinus Tachycardia Approval Criteria: B) The medication is prescribed by or in consultation with a cardiologist;

Ivabradine for any use not specified in the covered criteria is considered not medically necessary. This explicitly includes treatment of stable angina pectoris in patients without chronic heart failure, where evidence is insufficient and guideline guidance warns against routine addition of ivabradine in patients with normal left ventricular function.

Additional not medically necessary language: the policy considers use of ivabradine for indications outside the listed covered conditions to be not medically necessary. Specifically, addition of ivabradine for patients with chronic coronary disease and normal left ventricular function is described in guideline statements as potentially harmful, and therefore such use is not covered under this policy.

Coding and Clinical Thresholds

Drugs referencedNDC | mixed

Corlanor	ivabradine tablets and oral solution (brand)
ivabradine (generic)	ivabradine tablets (generic) and oral solution

Left ventricular ejection fraction — key clinical threshold

Left ventricular ejection fraction (LVEF)≤ 35% (currently or prior to initiation of ivabradine)

ApplicabilityAdult heart failure approval criterion for ivabradine (Corlanor and generic)

Approval durationTypical approval provided for 1 year when clinical criteria are met

Resting heart rate (adult HF) — key clinical threshold

Resting heart rate threshold (adult HF)≥ 70 beats per minute while in sinus rhythm

ContextRequired for adults with symptomatic chronic heart failure to reduce risk of hospitalization when on maximally tolerated beta blockers or with contraindication

Prior Authorization, Prescriber & Billing Requirements

Prior Authorization

Prior authorization required for ivabradine (Corlanor and generic)

Prior authorization is required for benefit coverage of ivabradine (Corlanor and generic). Approvals are provided for the duration noted (typically 1 year) when the clinical criteria in this policy are met. Documentation should demonstrate the indication and that the medication was prescribed by or in consultation with a cardiologist as described in the policy.

Approvals granted for 1 year when coverage criteria are met.
Prescribing or consultation by a cardiologist is required for approval.

Step Therapy

Beta blocker trial and generic-first requirement

For adult heart failure and inappropriate sinus tachycardia, the patient must have tried or be currently receiving one beta blocker for the condition OR have a documented contraindication to beta blocker therapy. For Employer Plans, a trial of the bioequivalent generic ivabradine product is required before Corlanor unless a formulation difference would, per the prescriber, cause a significant allergy or serious adverse reaction.

Definitions and Clinical Terms

Inappropriate Sinus Tachycardia — definition

DefinitionSinus heart rate > 100 beats per minute at rest

24-hour mean heart rateMean 24-hour heart rate > 90 beats per minute (not due to primary causes)

Clinical associationGenerally associated with distressing symptoms such as palpitations, weakness, dizziness, and syncope

Background

Ivabradine is a selective blocker of the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel and reduces heart rate by inhibiting the funny current (If) in the sinoatrial node. It is indicated to reduce hospitalizations for worsening chronic heart failure in adults with left ventricular ejection fraction ≤ 35% who are in sinus rhythm with a resting heart rate ≥ 70 bpm and who are on maximally tolerated beta blocker therapy or have a contraindication to beta blockers; it is also used in certain pediatric patients with dilated cardiomyopathy and has evidence for use in inappropriate sinus tachycardia.

Policy Revision History

2026-01-01addedLatest

Added preferred product table for Employer Plans (bioequivalent generic trial and exception for formulation-related allergy).

2025-10-15annual_revision

No clinical criteria changes noted on this annual revision.

2024-10-15annual_revision

Policy title changed from 'Ivabradine' to 'Cardiology - Ivabradine'; generic ivabradine tablets were added; adult HF LVEF criterion wording changed from referencing 'Corlanor' to 'ivabradine'; prescriber requirement added (medication prescribed by or in consultation with a cardiologist); multiple pediatric LVEF and age-specific heart rate criteria were removed.