CurrentCignaPolicy IP0286

Cardiology - Ivabradine

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This policy governs prior authorization and medical-necessity coverage for Corlanor (ivabradine tablets and oral solution) and generic ivabradine tablets for adult heart failure, pediatric heart failure due to dilated cardiomyopathy, and inappropriate sinus tachycardia under Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeMaterial policy update

Effective DateOct 15, 2026

Next Review DateN/A

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist.

SourceLink

POLICY UPDATE CHANGES

Generic ivabradine tablets were added to the policy.

The adult heart failure criterion was revised to refer to ivabradine rather than Corlanor for the LVEF requirement.

A cardiologist-prescribing or consultation requirement was added for covered indications.

Several pediatric heart failure criteria were removed, including the LVEF threshold, stable heart-failure treatment requirement, and age-specific resting-heart-rate thresholds.

A preferred-product table for Employer Plans was added.

The Employer Plans preferred-product requirement for Corlanor solution was revised to require inability to take generic tablets or inability to swallow or difficulty swallowing tablets.

PA requiredRequired for benefit coverage

1 yearApproval duration for each covered indication

LVEF ≤35%Adult heart failure ventricular-function threshold

≥70 bpmAdult heart failure resting-heart-rate threshold

3Covered indication categories

Coverage Criteria

FDA-approved indication: Adult heart failure

Approve for 1 year if ALL of the following are met.

Adult heart failure

Required clinical criteria
- Patient is at least 18 years of age.≥18 years
- Patient has a left ventricular ejection fraction (LVEF) of 35% or less, currently or prior to initiation of ivabradine therapy.LVEF ≤35%
- Patient is in normal sinus rhythm or sinus tachycardia with a resting heart rate of at least 70 beats per minute.Resting heart rate ≥70 beats per minute

Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeMaterial policy update

Effective DateOct 15, 2026

Next Review DateN/A

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentCignaPolicy IP0286

Cardiology - Ivabradine

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Get alerted when Policy IP0286 changes without checking for updates manually.

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Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeMaterial policy update

Effective DateOct 15, 2026

Next Review DateN/A

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist.

SourceLink

POLICY UPDATE CHANGES

Generic ivabradine tablets were added to the policy.

The adult heart failure criterion was revised to refer to ivabradine rather than Corlanor for the LVEF requirement.

A cardiologist-prescribing or consultation requirement was added for covered indications.

Several pediatric heart failure criteria were removed, including the LVEF threshold, stable heart-failure treatment requirement, and age-specific resting-heart-rate thresholds.

A preferred-product table for Employer Plans was added.

The Employer Plans preferred-product requirement for Corlanor solution was revised to require inability to take generic tablets or inability to swallow or difficulty swallowing tablets.

PA requiredRequired for benefit coverage

1 yearApproval duration for each covered indication

LVEF ≤35%Adult heart failure ventricular-function threshold

≥70 bpmAdult heart failure resting-heart-rate threshold

3Covered indication categories

Coverage Criteria

FDA-approved indication: Adult heart failure

Approve for 1 year if ALL of the following are met.

Adult heart failure

Required clinical criteria
- Patient is at least 18 years of age.≥18 years
- Patient has a left ventricular ejection fraction (LVEF) of 35% or less, currently or prior to initiation of ivabradine therapy.LVEF ≤35%
- Patient is in normal sinus rhythm or sinus tachycardia with a resting heart rate of at least 70 beats per minute.Resting heart rate ≥70 beats per minute

Policy Summary

PayerCigna

PolicyCardiology - Ivabradine

Policy CodePolicy IP0286

Change TypeMaterial policy update

Effective DateOct 15, 2026

Next Review DateN/A

Key ActionObtain prior authorization and ensure ivabradine is prescribed by or in consultation with a cardiologist.

SourceLink

On This Page

ONE of the following beta-blocker criteria

Patient has tried or is currently receiving one beta blocker for heart failure treatment.
Examples include metoprolol succinate sustained-release, carvedilol, bisoprolol, and Coreg CR (carvedilol extended-release capsules).
Patient has a contraindication to beta-blocker therapy.
Examples include bronchospastic disease such as chronic obstructive pulmonary disease or asthma, severe hypotension, or bradycardia.

FDA-approved indication: Pediatric heart failure due to dilated cardiomyopathy

Approve for 1 year if ALL of the following are met.

Pediatric heart failure due to dilated cardiomyopathy

Patient is less than 18 years of age.<18 years
The medication is prescribed by or in consultation with a cardiologist.
Preferred-product criteria are met for the requested product.

Other use with supportive evidence: Inappropriate sinus tachycardia

Approve for 1 year if ALL of the following are met.

Inappropriate sinus tachycardia

ONE of the following beta-blocker criteria
- Patient has tried or is currently receiving one beta blocker for inappropriate sinus tachycardia.
  Examples include metoprolol and bisoprolol.
- Patient has a contraindication to beta-blocker therapy.
  Examples include bronchospastic disease such as chronic obstructive pulmonary disease or asthma, severe hypotension, or bradycardia.
The medication is prescribed by or in consultation with a cardiologist.
Preferred-product criteria are met for the requested product.

Employer Plans preferred-product criteria

For Employer Plans, the applicable preferred-product criterion must be met.

Corlanor oral solution

Patient has tried and cannot take generic ivabradine tablets.
Patient cannot swallow or has difficulty swallowing tablets.

Corlanor tablets

Patient has tried the bioequivalent generic product, ivabradine tablets.
Patient cannot take the generic product because of a formulation difference in inactive ingredient(s) between the brand and bioequivalent generic product that would result, per the prescriber, in a significant allergy or serious adverse reaction.
Examples of inactive ingredients include dyes, fillers, and preservatives.

Condition not covered

Ivabradine for other uses is considered not medically necessary.

Stable angina without chronic heart failure: Ivabradine is requested for stable angina pectoris in a patient without chronic heart failure.

The policy states that this use is not medically necessary; in patients with chronic coronary disease and normal left ventricular function, adding ivabradine to standard anti-anginal therapy is potentially harmful.

Stable angina pectoris without chronic heart failure is not covered. Ivabradine requested for this use is considered not medically necessary; in patients with chronic coronary disease and normal left ventricular function, adding ivabradine to standard anti-anginal therapy may be potentially harmful.

Ivabradine is considered not medically necessary for any use other than the covered indications: adult heart failure, pediatric heart failure due to dilated cardiomyopathy, and inappropriate sinus tachycardia. The policy’s example is stable angina pectoris in patients without chronic heart failure; the list of noncovered uses may not be all inclusive.

Clinical Thresholds and Definitions Used in Criteria

Adult heart failure LVEF

Threshold35% or less

Applies toAdult heart failure coverage

Measurement timingCurrently or before initiation of ivabradine therapy

Adult heart failure resting heart rate

Threshold70 beats per minute or greater

Rhythm requirementNormal sinus rhythm or sinus tachycardia

Applies toAdult heart failure coverage

Adult heart failure age

Threshold18 years or older

Applies toAdult heart failure coverage

Approval period1 year when all criteria are met

Pediatric heart failure age

ThresholdUnder 18 years

Applies toHeart failure due to dilated cardiomyopathy in pediatric patients

Approval period1 year when all criteria are met

Provider Requirements and Denial Risks

Prior Authorization

Prior Authorization and Specialist Involvement

Prior authorization is required for benefit coverage of ivabradine. Approval requires the medication to be prescribed by, or prescribed in consultation with, a physician who specializes in the condition being treated; cardiologist involvement is specifically required under the clinical criteria.

Step Therapy

Verify Preferred Product Requirements

For Employer Plans, verify the required product pathway before submitting the request. Corlanor solution requires that the patient has tried and cannot take generic ivabradine tablets or cannot swallow or has difficulty swallowing tablets. Corlanor tablets require prior trial of bioequivalent generic ivabradine tablets and inability to take the generic because of an inactive-ingredient formulation difference that would, per the prescriber, cause a significant allergy or serious adverse reaction.

Corlanor solution (ivabradine solution): generic ivabradine tablets are not tolerated, or the patient cannot swallow or has difficulty swallowing tablets.
Corlanor tablets (ivabradine tablets): the patient has tried bioequivalent generic ivabradine tablets and cannot take them because of an inactive-ingredient formulation difference.
Generic ivabradine tablets: document use or attempted use when required by the applicable Employer Plan product criteria.

Documentation Required

Provide Indication-Specific Clinical Support

Submit clinical documentation supporting the specific indication and all applicable criteria. For heart failure, document age, diagnosis, current or pretreatment LVEF, rhythm and resting heart rate, and the applicable beta-blocker history or contraindication; for pediatric dilated cardiomyopathy or inappropriate sinus tachycardia, document the applicable diagnosis, age or other indication-specific facts, and required product criteria.

Adult heart failure: age ≥ 18 years; LVEF ≤ 35% currently or before ivabradine initiation; normal sinus rhythm or sinus tachycardia; resting heart rate ≥ 70 beats per minute.
Pediatric heart failure due to dilated cardiomyopathy: age < 18 years and documentation of the qualifying diagnosis.
Inappropriate sinus tachycardia: documentation of the diagnosis and the required beta-blocker history or contraindication.

Documentation Required

Document Beta-Blocker History or Contraindication

When applicable, document that the patient has tried or is currently receiving a beta blocker for the treated condition, or document a contraindication to beta-blocker therapy. Examples include metoprolol, carvedilol, bisoprolol, or Coreg CR for heart failure and metoprolol or bisoprolol for inappropriate sinus tachycardia; contraindication examples include bronchospastic disease such as COPD or asthma, severe hypotension, or bradycardia.

Record the beta blocker, indication, and trial or current-use status when therapy was tried or is ongoing.
If beta-blockers cannot be used, document the specific contraindication and its clinical basis.

Denial Risk

Authorization and Medical-Necessity Denial Risks

Requests and claims are at risk for denial when prior authorization is missing, required clinical criteria are not met or documented, preferred-product requirements are not satisfied, or ivabradine is used for a noncovered indication. Submit the request with complete supporting records and verify the applicable benefit plan because plan terms may differ.

Missing required authorization or specialist prescribing/consultation can result in nonapproval.
Failure to document the applicable age, diagnosis, clinical findings, beta-blocker requirement, or preferred-product criteria can result in denial.
Ivabradine for uses outside the covered criteria is not medically necessary.

Denial Risk

Stable Angina Without Chronic Heart Failure

Ivabradine for stable angina pectoris in patients without chronic heart failure is considered not medically necessary. Do not submit this use as a covered indication under this policy.

The policy notes that additional data are needed and cites guideline concern that adding ivabradine to standard anti-anginal therapy in chronic coronary disease with normal left ventricular function may be potentially harmful.

Billing Rule

Use Applicable Covered Billing Codes

Claims must be submitted with the most appropriate covered diagnosis and/or procedure code(s) applicable on the submission date. Claims for services not accompanied by applicable covered code(s), or billed for conditions or diagnoses not covered under the policy, will be denied as not covered.

Verify coding against the policy's Coding Information and the effective date of submission.
Unsupported or missing covered diagnosis/procedure codes create denial risk even when the clinical service was provided.

Clinical Background

Ivabradine is a hyperpolarization-activated cyclic nucleotide-gated channel blocker used in selected patients with heart failure and elevated heart rate. Coverage criteria address adult heart failure with reduced left ventricular ejection fraction and sinus rhythm or sinus tachycardia, pediatric stable symptomatic heart failure due to dilated cardiomyopathy, and inappropriate sinus tachycardia when the applicable requirements are met.

Key Definitions

Inappropriate sinus tachycardia

Resting heart rateSinus heart rate greater than 100 beats per minute at rest

Mean 24-hour heart rateGreater than 90 beats per minute

ExclusionNot due to primary causes

Left ventricular ejection fraction (LVEF)

DefinitionA measure of left ventricular systolic function

Adult heart failure threshold35% or less

Measurement timingCurrently or before initiation of ivabradine therapy