REPATHA (evolocumab) — CareFirst (Caremark)
Primary hyperlipidemia
Initial criteria
- Member had an untreated (before any lipid-lowering therapy) LDL-C level ≥ 190 mg/dL in the absence of a secondary cause.
- Member has a current LDL-C level ≥ 100 mg/dL after at least three months of treatment with a high-intensity statin dose in combination with ezetimibe; if unable to tolerate high-intensity statin, moderate-intensity statin may be used.
- OR Member has a current LDL-C level ≥ 100 mg/dL with a contraindication or intolerance to statins (see Appendix B).
Reauthorization criteria
- Member has achieved or maintained an LDL-C reduction (e.g., LDL-C is now at goal or robust lowering of LDL-C).
Approval duration
12 months