Nexlizet — CareFirst (Caremark)
Risk reduction of myocardial infarction and coronary revascularization
Initial criteria
- Patient age ≥ 18 years
- Patient has ANY of the following: established cardiovascular disease (CVD) OR a high risk for a CVD event but without established CVD
- Patient meets ONE of the following: (a) patient experienced an intolerance to recommended statin therapy, OR (b) patient has a contraindication that would prohibit use of statin therapy
Reauthorization criteria
- All patients (including new patients) requesting authorization for continuation of therapy must meet ALL requirements in the coverage criteria section
Approval duration
36 months