Nexlizet (bempedoic acid/ezetimibe) — Highmark

Initial criteria

• age ≥ 18 years
• Prescribed by or in consultation with a cardiologist OR lipid specialist OR endocrinologist
• Clinical documentation supporting the HeFH diagnosis (ICD-10: E78.01) AND one of the following:
• Genetic confirmation of one mutant allele at LDLR, ApoB, or PCSK9 gene locus OR
• Untreated LDL-C ≥ 190 mg/dL OR untreated LDL-C ≥ 160 mg/dL before age 20 AND one of the following physical signs of familial hypercholesterolemia: corneal arcus prior to 45 years of age, tendon xanthoma, tuberous xanthoma, or xanthelasma OR
• WHO criteria/Dutch Lipid Clinical Network score > 8 points OR 'definite' familial hypercholesterolemia per Simon Broome register