fenofibrate 150 mg capsules — Cigna
adjunct to diet to reduce low-density lipoprotein cholesterol (LDL-C), total cholesterol (total-C), triglycerides (TG) and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adults with primary hypercholesterolemia or mixed dyslipidemia
Preferred products
- generic fenofibrate capsules (43 mg, 67 mg, 134 mg, and 200 mg)
- generic fenofibrate tablets (48 mg, 54 mg, 145 mg, and 160 mg)
- generic fenofibric acid capsules (45 mg and 135 mg)
- generic fenofibric acid tablets (35 mg and 105 mg)
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product
Approval duration
1 year