CurrentCignaPolicy IP0286

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 applicable Cigna benefit plans.

Policy Summary

PayerCigna

PolicyIvabradine

Policy CodePolicy IP0286

Change TypeMaterial update

Effective DateNov 15, 20261d

Last ReviewOct 1, 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 an LVEF of 35% or less before initiation of ivabradine therapy rather than specifically Corlanor therapy.

A requirement was added that ivabradine be prescribed by or in consultation with a cardiologist.

Several pediatric heart failure criteria were removed, including LVEF of 45% or less, stable heart failure treatment, and age-specific resting heart-rate thresholds.

The Employer Plans preferred-product criteria for Corlanor solution were expanded to include cases where the patient's dose cannot be obtained with whole generic ivabradine tablets.

1 yearApproval duration

≤35%Adult heart failure LVEF threshold

≥70 bpmAdult heart failure resting heart rate

3Covered indication groups

<18 yearsPediatric age criterion

Not medically necessaryUses outside listed criteria

Covered and Noncovered Uses

FDA-Approved Indication: Adult Heart Failure

Covered when ALL of the following are met:

ALL of the following

Patient is ≥ 18 years of age.
Patient has a left ventricular ejection fraction (LVEF) ≤ 35% currently or prior to initiation of ivabradine therapy.
Patient is in normal sinus rhythm or sinus tachycardia with a resting heart rate of ≥ 70 beats per minute.
ONE of the following
- Patient has tried or is currently receiving one beta blocker for heart failure treatment.
  Examples of beta blockers include metoprolol succinate sustained-release, carvedilol, bisoprolol, and Coreg CR (carvedilol extended-release capsules).

Policy Summary

PayerCigna

PolicyIvabradine

Policy CodePolicy IP0286

Change TypeMaterial update

Effective DateNov 15, 20261d

Last ReviewOct 1, 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

Ivabradine

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Sign up for Cigna Policy IP0286 alerts

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

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Policy Summary

PayerCigna

PolicyIvabradine

Policy CodePolicy IP0286

Change TypeMaterial update

Effective DateNov 15, 20261d

Last ReviewOct 1, 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 an LVEF of 35% or less before initiation of ivabradine therapy rather than specifically Corlanor therapy.

A requirement was added that ivabradine be prescribed by or in consultation with a cardiologist.

Several pediatric heart failure criteria were removed, including LVEF of 45% or less, stable heart failure treatment, and age-specific resting heart-rate thresholds.

The Employer Plans preferred-product criteria for Corlanor solution were expanded to include cases where the patient's dose cannot be obtained with whole generic ivabradine tablets.

1 yearApproval duration

≤35%Adult heart failure LVEF threshold

≥70 bpmAdult heart failure resting heart rate

3Covered indication groups

<18 yearsPediatric age criterion

Not medically necessaryUses outside listed criteria

Covered and Noncovered Uses

FDA-Approved Indication: Adult Heart Failure

Covered when ALL of the following are met:

ALL of the following

Patient is ≥ 18 years of age.
Patient has a left ventricular ejection fraction (LVEF) ≤ 35% currently or prior to initiation of ivabradine therapy.
Patient is in normal sinus rhythm or sinus tachycardia with a resting heart rate of ≥ 70 beats per minute.
ONE of the following
- Patient has tried or is currently receiving one beta blocker for heart failure treatment.
  Examples of beta blockers include metoprolol succinate sustained-release, carvedilol, bisoprolol, and Coreg CR (carvedilol extended-release capsules).

Policy Summary

PayerCigna

PolicyIvabradine

Policy CodePolicy IP0286

Change TypeMaterial update

Effective DateNov 15, 20261d

Last ReviewOct 1, 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

Patient has a contraindication to use of beta blocker therapy, including bronchospastic disease such as chronic obstructive pulmonary disease or asthma, severe hypotension, or bradycardia.

FDA-Approved Indication: Heart Failure Due to Dilated Cardiomyopathy in Pediatric Patients

Covered when ALL of the following are met:

ALL of the following

Patient is < 18 years of age.
The medication is prescribed by or in consultation with a cardiologist.
Preferred product criteria is met for the product(s) as listed in the applicable table(s).

Other Use With Supportive Evidence: Inappropriate Sinus Tachycardia

Covered when ALL of the following are met:

ALL of the following

ONE of the following
- Patient has tried or is currently receiving one beta blocker for inappropriate sinus tachycardia.
  Examples of beta blockers include metoprolol and bisoprolol.
- Patient has a contraindication to use of beta blocker therapy, including 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 is met for the product(s) as listed in the applicable table(s).

Ivabradine for any other use is considered not medically necessary; this list may not be all inclusive, and criteria will be updated as new published data become available.

The 2023 American Heart Association/American College of Cardiology guidelines for chronic coronary disease state that, in patients with chronic coronary disease and normal left ventricular function, adding ivabradine to standard anti-anginal therapy is potentially harmful.

Clinical Thresholds

Adult heart failure — ventricular function

LVEF threshold≤35%

TimingMeasured currently or before initiation of ivabradine therapy

Applicable populationAdults with stable, symptomatic chronic heart failure

Adult heart failure — heart rate

Resting heart-rate threshold≥70 beats per minute

RhythmNormal sinus rhythm or sinus tachycardia

Applicable populationAdults with stable, symptomatic chronic heart failure and LVEF ≤35%

Pediatric heart failure — age

Age requirement<18 years

ConditionStable symptomatic heart failure due to dilated cardiomyopathy

Approval duration1 year when all policy criteria are met

Inappropriate sinus tachycardia — resting rate

Resting sinus heart rate>100 beats per minute at rest

Mean 24-hour heart rate>90 beats per minute

Diagnostic contextThe elevated heart rate is not due to primary causes

Inappropriate sinus tachycardia — 24-hour rate

Mean 24-hour heart-rate threshold>90 beats per minute

Resting sinus heart-rate threshold>100 beats per minute at rest

Associated conditionInappropriate sinus tachycardia not due to primary causes

Authorization, Prerequisites, and Product Selection

Prior Authorization

Prior Authorization and Specialist Involvement

Prior authorization is required for coverage of ivabradine. Approvals are issued for the duration specified by the applicable coverage criteria, and the medication must be prescribed by or in consultation with a physician specializing in the condition being treated, including a cardiologist for the covered indications described below.

Step Therapy

Adult Heart Failure Beta-Blocker Prerequisite

For adult heart failure, document that the patient has tried or is currently receiving a beta blocker for heart failure treatment, or has a contraindication to beta-blocker therapy. Examples of beta blockers include metoprolol succinate sustained-release, carvedilol, bisoprolol, and Coreg CR; contraindications may include bronchospastic disease such as COPD or asthma, severe hypotension, or bradycardia.

Unsupported block type: step_therapy ใ},{

Step Therapy

Corlanor Solution Requirements

For Employer Plans, Corlanor solution is preferred only when the patient meets at least one of the specified criteria.

The patient has tried and cannot take generic ivabradine tablets.
The patient cannot swallow or has difficulty swallowing tablets.
The patient’s dose cannot be obtained with whole generic ivabradine tablets.

Step Therapy

Corlanor Tablets Requirements

For Employer Plans, Corlanor tablets require a trial of bioequivalent generic ivabradine tablets and documentation that the patient cannot take the generic product because of a formulation difference in inactive ingredients that would, in the prescriber’s judgment, result in a significant allergy or serious adverse reaction.

Denial Risk

Noncovered Indications

Ivabradine is not covered for uses outside the covered indications and criteria. This includes uses other than adult heart failure, pediatric heart failure due to dilated cardiomyopathy, and inappropriate sinus tachycardia.

Other adult uses are not covered.
Pediatric uses other than heart failure due to dilated cardiomyopathy are not covered.
Uses other than inappropriate sinus tachycardia under the supportive-evidence criteria are not covered.

Denial Risk

Missing Covered Codes

Claims submitted without an applicable covered diagnosis or procedure code under the policy may be denied as not covered. Providers must use the most appropriate codes in effect on the submission date.

Confirm that the claim includes the applicable covered diagnosis and/or procedure code(s).
Services billed for conditions or diagnoses not covered under the policy are not reimbursable.

Ivabradine Overview

Ivabradine is a hyperpolarization-activated cyclic nucleotide-gated channel blocker used in selected patients with heart failure and elevated sinus rates. The policy addresses adult stable symptomatic chronic heart failure with reduced left ventricular ejection fraction, pediatric stable symptomatic heart failure due to dilated cardiomyopathy, and inappropriate sinus tachycardia when the applicable coverage criteria are met.

Inappropriate Sinus Tachycardia

Inappropriate sinus tachycardia

Resting sinus heart rate>100 beats per minute at rest

Mean 24-hour heart rate>90 beats per minute

Exclusion from definitionThe tachycardia is not due to primary causes

Common symptomsPalpitations, weakness, dizziness, or syncope