CurrentUnitedHealthcarePolicy N/A

Corlanor (ivabradine) prior authorization

Prior authorization and reauthorization requirements for Corlanor (ivabradine) for UnitedHealthcare members, including criteria for heart failure, pediatric dilated cardiomyopathy, and inappropriate sinus tachycardia.

Policy Summary

PayerUnitedHealthcare

PolicyCorlanor (ivabradine) prior authorization

Policy CodePolicy N/A

Change TypeRoutine review — no material changes

Effective DateNov 16, 2025

Next Review DateSep 1, 2025

Key ActionSubmit prior authorization showing patient meets clinical criteria (EF <35%, in sinus rhythm, resting HR >70 bpm, and beta‑blocker optimization or contraindication); approvals are issued for 12 months.

SourceLink

12 monthsauth duration

EF <35%EF threshold

>70 bpmresting HR

≥6 monthspediatric age

sinus rhythmcardiac rhythm

Coverage Criteria for Ivabradine (Corlanor)

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.

Initial Therapy — Covered when ANY of the following groups of conditions are met

Covered when ANY of the following groups of conditions are met:

Initial Therapy options

1. Chronic symptomatic heart failure: Worsening stable symptomatic chronic heart failure (e.g., NYHA II–IV) AND left ventricular ejection fraction (EF) < 35% AND patient is in sinus rhythm AND resting heart rate > 70 beats per minute AND (patient is on maximum tolerated doses of beta-blockers OR has a contraindication/intolerance to beta-blocker therapy)
2. Pediatric or adult dilated cardiomyopathy (DCM): Diagnosis of stable symptomatic heart failure due to dilated cardiomyopathy (DCM) AND patient is in sinus rhythm AND patient has an elevated heart rate
Pediatric DCM indication applies to patients aged 6 months and older per background
3. Inappropriate sinus tachycardia (IST): Diagnosis of inappropriate sinus tachycardia (IST) AND patient is in sinus rhythm
IST is not an FDA-approved indication but is included in these criteria

Reauthorization — Reauthorization covered when the following is met

Reauthorization covered when the following is met:

Reauthorization: Documentation of positive clinical response to Corlanor (ivabradine) therapy

Authorization issued for 12 months

No additional exclusionary criteria are listed beyond failure to meet the explicit clinical requirements in the coverage criteria. Per program rules, UnitedHealthcare may approve initial or reauthorization requests based solely on prior claim/medication history and diagnosis codes through automated processes when those records demonstrate the member previously received Corlanor under the covered indications. Authorization for approvals that meet criteria is issued for 12 months.

Requests that do not meet the listed clinical criteria should be considered not medically necessary. Examples include: left ventricular ejection fraction ≥ 35%, not in sinus rhythm, resting heart rate ≤ 70 beats per minute, or absence of documentation that the patient is on maximally tolerated beta‑blocker dosing or has a documented contraindication/intolerance to beta‑blocker therapy. Such requests risk denial unless other supporting documentation justifying therapy is provided.

Key Clinical Thresholds and References

Referenced clinical literature / package insertmixed

No codes listed

inv-06: Resting heart rate — required threshold for chronic heart failure indication

Required resting heart rate> 70 beats per minute

ContextApplies to chronic symptomatic heart failure indication when patient is in sinus rhythm

Use for reauthorizationAuthorization duration is 12 months when criteria are met

inv-07: Left ventricular ejection fraction — required threshold for primary heart failure indication

Required left ventricular ejection fraction (LVEF)< 35%

ContextRequirement for primary chronic heart failure indication (patient must also be in sinus rhythm)

ConsequenceRequests with EF ≥ 35% are at risk for denial as not meeting criteria

Provider Requirements, Documentation, and Denial Triggers

Prior Authorization

Prior Authorization Required

Prior authorization required for initial therapy. When clinical criteria are met, initial approvals will be issued for 12 months.

Authorization duration: 12 months

Documentation Required

Beta-Blocker Optimization Requirement

Patient must be on maximally tolerated beta-blocker therapy or have a documented contraindication or intolerance to beta-blockers prior to approval.

Examples of beta-blockers: carvedilol, metoprolol succinate, bisoprolol

Documentation Required

Required Documentation for Reauthorization

For reauthorization, documentation of positive clinical response to therapy is required. UnitedHealthcare may also approve initial or reauthorization requests based solely on prior claim/medication history, diagnosis codes (ICD-10), and/or claim logic where program rules allow.

Reauthorization documentation: evidence of clinical improvement while on therapy
Automated approvals: may be used based on claims/medication history and diagnosis codes

Denial Risk

Denial Triggers

Requests that do not meet the clinical criteria are subject to denial. Common denial triggers include: left ventricular ejection fraction (EF) ≥ 35%, not in sinus rhythm, resting heart rate ≤ 70 bpm, lack of documentation of beta-blocker optimization or contraindication/intolerance, or absence of documentation of positive clinical response for reauthorization.

Denial triggers: EF ≥ 35%; not in sinus rhythm; resting HR ≤ 70 bpm; no documentation of maximum tolerated beta-blocker or contraindication/intolerance; insufficient documentation for reauthorization

Step	Requirement
1	Patient is on maximally tolerated doses of beta‑blockers (e.g., carvedilol, metoprolol succinate, bisoprolol) OR has a contraindication or intolerance to beta‑blocker therapy

Definitions and Special Populations

inv-13: Inappropriate sinus tachycardia (IST) — definition and note about non-FDA-approved indication

DefinitionInappropriate sinus tachycardia (IST): a diagnosis of sinus tachycardia for which ivabradine has shown efficacy

Regulatory noteIST is not an FDA-approved indication for Corlanor; inclusion here reflects evidence of efficacy but is off-label

Coverage conditionWhen IST is documented, patient must be in sinus rhythm to meet criteria for approval

inv-14: Pediatric dilated cardiomyopathy (DCM) — definition for pediatric use (age ≥ 6 months)

DefinitionPediatric dilated cardiomyopathy (DCM): stable symptomatic heart failure due to DCM in pediatric patients aged 6 months and older

Age thresholdApplies to pediatric patients aged ≥ 6 months

Coverage conditionsPatient must be in sinus rhythm and have an elevated heart rate to meet the pediatric DCM criteria

Background and Drug Information

Ivabradine (Corlanor) is a hyperpolarization‑activated cyclic nucleotide‑gated (HCN) channel blocker used to reduce the risk of heart failure hospitalization in patients with stable, symptomatic chronic heart failure meeting specific physiologic criteria. The covered chronic heart failure indication requires left ventricular ejection fraction < 35%, the patient to be in sinus rhythm with a resting heart rate > 70 beats per minute, and either treatment with maximally tolerated beta‑blocker dosing or a documented contraindication/intolerance to beta‑blockers. Ivabradine is also covered for stable symptomatic heart failure due to dilated cardiomyopathy in pediatric patients (age and specific age-related guidance referenced elsewhere in the policy) and for inappropriate sinus tachycardia (IST) in patients who are in sinus rhythm.