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Praluent (alirocumab) — Cigna

Primary Hyperlipidemia

Initial criteria

  • Prescriber confirms diagnosis of primary hyperlipidemia
  • If patient statin intolerant, criteria for statin intolerance must be met [(1) or (2)]: (1) Statin-related rhabdomyolysis, OR (2) Skeletal-related muscle symptoms on both atorvastatin and rosuvastatin which resolve on discontinuation

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)