CurrentCignaPolicy N/A

Calcium Channel Blockers - Verapamil Products Step Therapy Policy

Defines step therapy requirements for verapamil (calcium channel blocker) products for Cigna-administered health benefit plans; applies to prescribers and pharmacy/prior authorization processes for affected verapamil formulations.

Policy Summary

PayerCigna

PolicyCalcium Channel Blockers - Verapamil Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeRevised and removed products

Effective DateN/A

Next Review DateJun 18, 2025

Key ActionRequire trial of a Step 1 verapamil product (specified generics) before approving a Step 2 product; if one Step 1 product has been tried, approve Step 2 for up to 1 year.

SourceLink

POLICY UPDATE CHANGES

Generic verapamil extended-release PM capsules were moved from Step 1 to Step 2 previously, and recent revisions added generic verapamil extended-release tablets and generic verapamil sustained-release capsules to Step 1.

Calan SR and Verelan brand products were removed from Step 2 because they are no longer available.

Step 1preferred initial verapamil products (generics)

Step 2Verelan PM placement

1 yearapproval duration

NCapplicable state

Step Therapy Coverage Criteria

Step 2 (Verelan PM) coverage criteria

Covered when ALL of the following are met

Step Therapy requirement: Patient has tried one Step 1 product prior to Step 2trial of >=1 Step 1 product

If met, approve Step 2 product for up to 1 year

Any use of a Step 2 product that does not meet the step therapy criteria is considered not medically necessary.

Any other exception beyond the specified step therapy criteria is considered not medically necessary.

Relevant Billing and Coding

Relevant billing codes (not specified)mixed

affected codes

Document references that requests must use appropriate covered diagnosis and/or procedure codes; no specific codes listed in policy.

Policy Summary

PayerCigna

PolicyCalcium Channel Blockers - Verapamil Products Step Therapy Policy

Policy CodePolicy N/A

Change TypeRevised and removed products

Effective DateN/A

Next Review DateJun 18, 2025

Key ActionRequire trial of a Step 1 verapamil product (specified generics) before approving a Step 2 product; if one Step 1 product has been tried, approve Step 2 for up to 1 year.

SourceLink

On This Page

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Prior Authorization

Prior Authorization and Documentation Requirements

Requests should be submitted with applicable covered diagnosis/procedure codes and supporting documentation per the applicable benefit plan.

All approvals are provided for 1 year in duration.
Step Therapy prior authorization requires trial of a Step 1 product before approving a Step 2 product; if the Step Therapy rule is not met at point of service, coverage will be determined by the Step Therapy criteria.

Step Therapy

Step Therapy Requirement

This program requires use of a Step 1 verapamil product (specified generics) prior to coverage of a Step 2 product (Verelan PM brand or generic). Coverage for a Step 2 verapamil product will be determined by the Step Therapy criteria if the Step Therapy rule is not met at point of service.

Step 1 products: generic verapamil extended‑release capsules, generic verapamil extended‑release tablets, generic verapamil immediate‑release tablets, generic verapamil sustained‑release capsules.
Step 2 products: Verelan PM (brand and generic).
Approvals are for 1 year.

Documentation Required

Supporting Documentation Needed

Providers must submit supporting clinical documentation to justify any exceptions to the Step Therapy requirement or to demonstrate medical necessity for coverage.

Include relevant clinical notes, prior medication history showing trials of Step 1 products, and applicable diagnosis/procedure codes.
Requests lacking appropriate codes or documentation may be denied as not covered.

Key Terms and Formulations

Verelan PM (COER) — definition and clinical context

DefinitionVerelan PM (COER) is an extended‑release controlled‑onset formulation of verapamil designed to release drug 4–5 hours after ingestion with once‑daily bedtime administration to achieve peak morning concentrations.

Indication summaryAll verapamil formulations indicated for hypertension; immediate‑release verapamil also indicated for angina and specific cardiac arrhythmias.

Chronotherapy conceptCOER formulations are intended to synchronize verapamil concentrations with biological rhythms (peak in morning) to potentially attenuate morning rises in blood pressure and related physiologic changes.

Evidence noteChronotherapeutic advantage of COER verapamil has not been demonstrated in controlled comparative trials (CONVINCE trial did not provide evidence to support chronotherapeutics).

Clinical Background

Verapamil formulations are indicated for the treatment of hypertension; immediate‑release verapamil is also indicated for angina and certain arrhythmias. Verelan PM is a controlled‑onset extended‑release (COER) formulation designed for once‑daily bedtime dosing to release drug approximately 4–5 hours after ingestion and achieve peak morning concentrations. Chronotherapeutic advantages of COER formulations have not been demonstrated conclusively in controlled comparative trials.

This policy implements a step therapy program for verapamil products: preferred initial agents are Step 1 (generic verapamil formulations), and Verelan PM (brand and generic) is placed in Step 2. The program requires trial of at least one Step 1 product prior to approval of a Step 2 product; if that trial is met, a Step 2 product may be approved for up to 1 year.

OpenPayer

Calcium Channel Blockers - Verapamil Products Step Therapy Policy

Step Therapy Coverage Criteria

Relevant Billing and Coding

What Providers Must Do

Key Terms and Formulations

Clinical Background