Cytokinetics’ Myqorzo is On Track For a Significant Label Expansion into nHCM, Where In-Class Rival Camzyos Failed. Payers are the Next Challenge.
At the end of 2025, Myqorzo (Cytokinetics) received approval in obstructive hypertrophic cardiomyopathy (oHCM), a rare genetic heart condition where the heart muscle thickens and blood flow out of the heart is reduced. This approval came two and a half years after fellow cardiac myosin inhibitor, Camzyos (Bristol Myers Squibb) became the first disease-modifying therapy in this indication. Both agents offer near-identical Clinical Innovation over antiarrhythmics alone, with Myqorzo scoring better on safety. [1,2] (Figure 1)
Figure 1: Drivers of Clinical Innovation for Camzyos and Myqorzo, Each Compared with Its Respective Control Arm
Myqorzo’s significant time lag in approval is likely to dampen its commercial outlook in oHCM, which, until now, was going to have to rely on its superior safety and dosing flexibility to drive adoption. However, following August 28th, when data from the phase III ACACIA-HCM trial in non-obstructive hypertrophic cardiomyopathy (nHCM) were presented at the European Society of Cardiology Congress as well as published in the New England Journal of Medicine, Cytokinetics now has a chance to change the narrative from being non-inferior with a safety play into being the “one-size-fits-all” HCM drug. [3, 4] Whereas Camzyos failed to differentiate itself from antiarrhythmics in in its phase III ODYSSEY-HCM trial, Myqorzo showed considerable efficacy in nHCM, albeit less dramatic than in the obstructive population. Most notably, it achieved +0.67 mL/kg/min difference in improvement in partial pressure of mixed venous oxygen (PvO2) from baseline, when compared to the control arm.
Myqorzo’s U.S. wholesale acquisition cost (WAC) comes in at about $397 per day, just $6 more than Camzyos. While Myqorzo offers strong clinical benefit in oHCM and is unlikely to face substantial reimbursement friction, the same cannot be said in nHCM. Since the drug’s clinical benefit in the non-obstructive population is only one-third of its clinical benefit in the obstructive population, the $397 per day price point becomes a concern.
Below in Figure 2, we have plotted a variety of commercially successful drugs in gray. These drugs tend to be to the right of the dotted line, which represents the place where drugs claw back half of their clinical benefit in increased cost, illustrating the fact that the prices of successful drugs typically claw back less than 50% of the clinical benefit that they deliver. In oHCM, both Camzyos and Myqorzo sit comfortably to the right of that 50% value line, suggesting they are appropriately priced for that indication. However, when we consider Myqorzo in nHCM (the green data point) we see its price claws back over 100% of its clinical benefit.
Figure 2: Market Access in Obstructive and Non-Obstructive HCM
As a result, Cytokinetics faces a challenge in finding the right price point for Myqorzo across both indications. As it currently stands, we predict that when Myqorzo receives its likely label expansion in 2027, it will see slower adoption than it and its in-class competitor are seeing in oHCM.
[1] Maron MS, Masri A, Nassif ME, et al; SEQUOIA-HCM Investigators. Aficamten for symptomatic obstructive hypertrophic cardiomyopathy. N Engl J Med. 2024;390(20):1849-1861. doi:10.1056/NEJMoa2401424
[2] Olivotto I, Oreziak A, Barriales-Villa R, et al; EXPLORER-HCM study investigators. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2020;396(10253):759-769. doi:10.1016/S0140-6736(20)31792-X
[3] Masri A, Maron MS, Bhatia A, et al. Aficamten for symptomatic nonobstructive hypertrophic cardiomyopathy. N Engl J Med. Published online August 28, 2026. doi:10.1056/NEJMoa2603021
[4] Aficamten trial brings positive news for patients living with non-obstructive hypertrophic cardiomyopathy. European Society of Cardiology. August 28, 2026. Accessed September 1, 2026. https://www.escardio.org/news/press/press-releases/aficamten-trial-brings-positive-news-for-patients-living-with-non-obstructive-hypertrophic-cardiomyopathy/
[5] Bjerregaard L, Dybro AM, Saaby L, Poulsen SH, Rasmussen TB, Jensen MSK. Beta-Blocker (Bisoprolol) vs Calcium-Channel Blocker (Verapamil) in Nonobstructive Hypertrophic Cardiomyopathy: A Randomized Triple-Crossover Physiologic Trial. J Am Coll Cardiol. 2026 Mar 3;87(8):1063-1083. doi: 10.1016/j.jacc.2025.11.028. PMID: 41778690.