Nexlizet — Cigna

Established Atherosclerotic Cardiovascular Disease (ASCVD)

Initial criteria

Patient is ≥ 18 years of age; AND
Patient meets ONE of the following (a–f): a) history of myocardial infarction; OR b) stable or unstable angina; OR c) past history of stroke or transient ischemic attack; OR d) coronary artery disease; OR e) peripheral arterial disease; OR f) history of coronary or other arterial revascularization procedure; AND
Patient meets ONE of the following (a or b): a) BOTH (1) tried one high-intensity statin (atorvastatin ≥ 40 mg daily or rosuvastatin ≥ 20 mg daily as single-entity or combination) for ≥ 8 continuous weeks AND (2) LDL-C after therapy remains ≥ 55 mg/dL; OR b) statin intolerant defined as ONE of the following: (1) experienced statin-related rhabdomyolysis; OR (2) ALL of: (a) experienced skeletal-related muscle symptoms (e.g., myopathy, myalgia); AND (b) symptoms occurred with separate trials of both atorvastatin and rosuvastatin (single-entity or combination); AND (c) symptoms resolved upon discontinuation of each respective statin)

Patient currently receiving Nexlizet AND prescriber confirms a response to therapy (e.g., decreased LDL-C, total cholesterol, non-HDL-C, or apolipoprotein B levels)

1 year