Vascepa (icosapent ethyl capsules – Amarin, generic) — Cigna
Hypertriglyceridemia with Triglyceride Levels ≥ 500 mg/dL
Initial criteria
- Prior to initiation of therapy, the patient had a fasting baseline triglyceride level ≥ 500 mg/dL
- Patient has tried, or is currently receiving, one of the following products: niacin (immediate-release or extended-release), a fibrate, or a statin
Approval duration
1 year