CurrentUnitedHealthcarePolicy 2026 P 2394-1

Myqorzo (aficamten) prior authorization / medical necessity

UnitedHealthcare prior authorization and medical necessity policy for Myqorzo (aficamten) for treatment of adults with symptomatic obstructive hypertrophic cardiomyopathy (oHCM), detailing initial and reauthorization clinical criteria, prescribing requirements, and authorization duration.

Policy Summary

PayerUnitedHealthcare

PolicyMyqorzo (aficamten) prior authorization / medical necessity

Policy CodePolicy 2026 P 2394-1

Change TypeNew program

Effective DateMay 1, 2026

Next Review Date

Key ActionPrior authorization / medical necessity determination required; approvals granted when all initial or reauthorization criteria are met.

POLICY UPDATE CHANGES

New program created for Myqorzo (aficamten) with P&T approval 2/2026 and effective date 5/1/2026.

12 monthsAuthorization Duration

Adults with symptomatic oHCMCovered Population

>=55% (init) / >=50% (reauth)Key LVEF thresholds

Coverage Summary

UnitedHealthcare prior authorization and medical necessity policy for Myqorzo (aficamten) for treatment of adults with symptomatic obstructive hypertrophic cardiomyopathy (oHCM). Effective Date: 5/1/2026. Authorization Duration: 12 months. Policy Number: 2026 P 2394-1. Status: CURRENT. Coverage stance: covered_with_criteria.