Nexlizet — Cigna

Primary Hyperlipidemia

Initial criteria

Patient is ≥ 18 years of age; AND
Patient meets ONE of the following: a) coronary artery calcium score ≥ 300 Agatston units; OR b) diabetes; 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) AND (2) LDL-C remains ≥ 70 mg/dL; OR b) statin intolerant defined as ONE of: (1) statin-related rhabdomyolysis; OR (2) ALL of: (a) skeletal-related muscle symptoms (myopathy or myalgia); AND (b) symptoms occurred with separate trials of both atorvastatin and rosuvastatin (single-entity or combination); AND (c) symptoms resolved upon discontinuation)

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