Roszet — Cigna
primary hypercholesterolemia
Preferred products
- atorvastatin
- atorvastatin/amlodipine
- ezetimibe/simvastatin
- fluvastatin
- fluvastatin extended-release
- lovastatin
- pravastatin
- pitavastatin
- rosuvastatin
- simvastatin
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product.
- If the patient cannot swallow or has difficulty swallowing tablets or capsules, approve Atorvaliq, Flolipid, or Ezallor Sprinkle.
- NOTE: When compliance with the Affordable Care Act, Health Resources and Services Administration Guidelines, and Public Health Services Act section 2713 is required and the conditions for coverage listed under the Criteria are not met, approval is granted when the requested single-entity drug is used for the primary prevention of cardiovascular disease (CVD) in an adult aged 40 to 75 years who has one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) AND an estimated 10-year CVD event risk of 10% or greater AND who does NOT have a history of (or signs or symptoms of) CVD AND, according to the prescriber, the alternative Step 1 Products would not be as medically appropriate for the patient as the requested single-entity drug.
Approval duration
1 year