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.

SourceLink

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.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.