statin — Blue Cross Blue Shield of Alabama
primary prevention of cardiovascular disease (CVD)
Initial criteria
- - The requested statin is covered under the pharmacy benefit or has been approved through the coverage exception process
- - There is support that the requested statin is medically necessary
- - The requested statin is for use in the primary prevention of cardiovascular disease (CVD)
- - The patient is age 40–75 years (inclusive)
- - The patient has at least one of the following risk factors: • Dyslipidemia • Diabetes • Hypertension • Smoking
- - The patient has a calculated 10-year risk of a cardiovascular event of 10% or greater per the American College of Cardiology and American Heart Association’s ASCVD calculator
Approval duration
12 months