Myalept — CareFirst (Caremark)

Partial lipodystrophy in patients with confirmed leptin deficiency and metabolic abnormalities

Initial criteria

Member has a diagnosis of congenital generalized lipodystrophy (Berardinelli-Seip syndrome), acquired generalized lipodystrophy (Lawrence syndrome), or partial lipodystrophy
Member has leptin deficiency confirmed by laboratory testing (less than 12 ng/ml)
Member has at least one complication of lipodystrophy (e.g., diabetes mellitus, hypertriglyceridemia, increased fasting insulin level)
Member does not have HIV-related lipodystrophy
Member does not have generalized obesity not associated with generalized lipodystrophy

Member has experienced an improvement from baseline in metabolic control (e.g., improved glycemic control, decrease in triglycerides, or decrease in hepatic enzyme levels)

Initial: 6 months; Reauthorization: 12 months