olezarsen — CareFirst (Caremark)

Initial criteria

• Member has a confirmed FCS diagnosis by genetic testing (i.e., biallelic pathogenic variants in FCS-causing genes [e.g., LPL, GPIHBP1, APOA5, APO2, LMF1, GPD1, CREB3L3]).
• Member has a fasting triglycerides (TG) level of ≥ 880 mg/dL.
• Member is currently receiving a very-low fat diet (e.g., less than 20 to 30 g of total fat per day, 10% to 15% of calories per day of fat).

Reauthorization criteria

• Member has demonstrated a positive clinical response with the requested medication (e.g., reduction in TG level from baseline, reduction in episodes of acute pancreatitis).
• Member is currently receiving a very-low fat diet (e.g., less than 20 to 30 g of total fat per day, 10% to 15% of calories of fat).

Approval duration

12 months