CurrentUnitedHealthcarePolicy N/A

Myqorzo (aficamten) prior authorization

Prior authorization requirements for Myqorzo (aficamten) for treatment of adults with symptomatic obstructive hypertrophic cardiomyopathy; applies to UnitedHealthcare medical/pharmacy plans and providers seeking coverage. State mandates and member-specific benefits may also affect coverage.

Policy Summary

PayerUnitedHealthcare

PolicyMyqorzo (aficamten) prior authorization

Policy CodePolicy N/A

Change TypeNew policy

Effective DateMay 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization documenting diagnosis of obstructive hypertrophic cardiomyopathy and that Myqorzo will not be used with another cardiac myosin inhibitor.

SourceLink

POLICY UPDATE CHANGES

New prior authorization program for Myqorzo (aficamten) established with P&T approval in February 2026 and effective 5/1/2026.

Prior Auth/Notifprogram type

Adults with oHCMindication population

12 moinitial authorization duration

12 more-authorization duration

Coverage Criteria

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inv-01: COVERAGE CRITERIA

Covered when ALL of the following are met for initial authorization:

Initial Authorization

Diagnosis of obstructive hypertrophic cardiomyopathy (HCM)
Therapy exclusion: Not used in combination with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten)
Authorization will be issued for 12 months.

inv-02: COVERAGE CRITERIA

Covered when ALL of the following are met for reauthorization:

Reauthorization

Clinical response: Documentation of positive clinical response to Myqorzo therapy
Therapy exclusion: Not used in combination with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten)
Authorization will be issued for 12 months.

Concomitant administration of Myqorzo (aficamten) with another cardiac myosin inhibitor is not allowed. Specifically, therapy used in combination with Camzyos (mavacamten) or any other cardiac myosin inhibitor is excluded from approval. Requests documenting concurrent use with another cardiac myosin inhibitor do not meet the stated coverage criteria and may be denied. Authorization will be issued for 12 months only when non‑concomitant use is confirmed.

Initial Therapy Criteria

inv-11: INITIAL THERAPY CRITERIA

Initial authorization requirements for Myqorzo:

Initial Therapy

Diagnosis of obstructive hypertrophic cardiomyopathy (HCM)
Therapy exclusion: Not used in combination with another cardiac myosin inhibitor
Authorization will be issued for 12 months.

Continuation / Reauthorization Criteria

inv-12: CONTINUATION CRITERIA

Reauthorization/continuation rules:

Continuation

Clinical response: Documentation of positive clinical response to Myqorzo therapy
Therapy exclusion: Not used in combination with another cardiac myosin inhibitor
Authorization will be issued for 12 months.

Provider Actions & Prior Authorization Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for initial Myqorzo therapy. Approval will be issued for 12 months when BOTH of the following are met: a diagnosis of obstructive hypertrophic cardiomyopathy (HCM) and the request documents that Myqorzo will not be used in combination with another cardiac myosin inhibitor (for example, Camzyos [mavacamten]).

Initial approval duration: 12 months
Required diagnosis: obstructive hypertrophic cardiomyopathy (HCM)
Not used in combination with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten)

Documentation Required

Reauthorization Documentation Required

Reauthorization (continuation) also requires prior authorization and will be issued for 12 months when BOTH of the following are documented: positive clinical response to Myqorzo therapy and that Myqorzo is not being used in combination with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten).

Reauthorization requirement: documentation of positive clinical response to Myqorzo
Reauthorization duration: 12 months
Must not be used concomitantly with another cardiac myosin inhibitor

Denial Risk

Denial Triggers

Requests that do not include a diagnosis of obstructive hypertrophic cardiomyopathy or that document concurrent use of Myqorzo with another cardiac myosin inhibitor may be denied.

Denial triggers: missing diagnosis of obstructive HCM
Denial triggers: concurrent use with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten)

Note

Program Automation & Limits

UnitedHealthcare may use automated approval or re-approval processes based on prior claim or medication history, diagnosis codes (ICD-10), and claim logic. Program-specific rules may impose supply limits and member-specific limits; supply limits and Medical Necessity reviews may apply.

Automated approval may use prior claims/medication history and ICD-10 diagnosis codes
Supply limits and member-specific rules may apply
Use of automation varies by program/therapeutic class

Definitions

Not used in combination

DefinitionTherapy must not be administered concomitantly with another cardiac myosin inhibitor (e.g., Camzyos/mavacamten).

ScopeApplies to initial authorization and reauthorization decisions for Myqorzo (aficamten).

ConsequenceRequests documenting concurrent use with another cardiac myosin inhibitor do not meet approval criteria and may be denied.

Indication

IndicationTreatment of adults with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) to improve functional capacity and symptoms.

PopulationAdults with symptomatic oHCM.

DrugMyqorzo (aficamten), a cardiac myosin inhibitor.