Repatha (evolocumab subcutaneous injection - Amgen) — Cigna
Primary Hyperlipidemia
Initial criteria
- Patient meets indication-specific Initial Therapy criteria as defined in policy (see related sections)
- If patient has not previously received approval from the Coverage Review Department and is currently receiving or restarting Repatha, must meet Initial Therapy criteria
Reauthorization criteria
- Patient is currently receiving Repatha
- According to the prescriber, the patient has experienced a response to therapy