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Praluent (alirocumab) — Cigna

Established Cardiovascular Disease

Initial criteria

  • Prescriber confirms diagnosis of established cardiovascular disease
  • Patient has been determined to be statin intolerant by meeting ONE of the following [(1) or (2)]: (1) Patient experienced statin-related rhabdomyolysis; OR (2) Patient meets ALL of the following [(a), (b), and (c)]: (a) Patient experienced skeletal-related muscle symptoms; AND (b) The skeletal-muscle related symptoms occurred while receiving separate trials of both atorvastatin and rosuvastatin (as single-entity or combination products); AND (c) Skeletal-related muscle symptoms resolved upon discontinuation of each respective statin therapy (atorvastatin and rosuvastatin)

Reauthorization criteria

  • According to the prescriber, the patient has experienced a response to therapy (e.g., decreasing LDL-C, total cholesterol, non-HDL-C, or apolipoprotein B levels)