Nexlizet — CareFirst (Caremark)
Primary hyperlipidemia (including heterozygous familial hypercholesterolemia (HeFH))
Initial criteria
- Patient age ≥ 18 years
- Requested drug is being prescribed as an adjunct to diet
- Patient meets ONE of the following: (a) requested drug will be used in combination with other low-density lipoprotein cholesterol (LDL-C) lowering therapies, OR (b) concomitant use of the requested drug with other LDL-C lowering therapies is NOT possible
Reauthorization criteria
- Requested drug is being prescribed as an adjunct to diet
- Patient has achieved or maintained a reduction in low-density lipoprotein cholesterol (LDL-C) from baseline
Approval duration
36 months