Lodoco (colchicine) — Highmark

Preferred products

• Repatha

Initial criteria

• age ≥ 18 years
• Diagnosis of one of the following: established atherosclerotic disease (ICD-10: I70) supported by one of the following: acute coronary syndrome OR coronary or other arterial revascularization OR history of myocardial infarction OR history of stroke OR history of transient ischemic attack OR peripheral arterial disease presumed to be of atherosclerotic origin OR stable or unstable angina; OR multiple risk factors for cardiovascular disease (e.g., high cholesterol, high blood pressure, obesity, diabetes, smoking)
• Lodoco is used to reduce the risk of myocardial infarction, stroke, coronary revascularization, or cardiovascular death
• Member has experienced therapeutic failure to a maximally tolerated statin OR is statin intolerant defined as: while receiving at least two separate trials of different statins, experienced statin related rhabdomyolysis or skeletal-related muscle symptoms that resolved upon discontinuation of the statins; OR experienced creatinine kinase increase to 10 times ULN, liver function tests increase to 3 times ULN, or hospitalization due to severe statin-related adverse event (e.g., rhabdomyolysis)
• Member has experienced therapeutic failure, contraindication, or intolerance to plan-preferred Repatha

Reauthorization criteria

• Prescriber attests that the member has experienced positive clinical response to therapy

Approval duration

12 months