Nexletol — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Patient meets ONE of: coronary artery calcium score ≥ 300 Agatston units OR has diabetes
• Patient meets ONE of: (a) tried one high-intensity statin (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg daily single or combo) AND statin + ezetimibe for ≥ 8 weeks AND LDL-C remains ≥ 70 mg/dL OR (b) statin intolerant (statin-related rhabdomyolysis OR skeletal muscle symptoms occurred during trials of atorvastatin and rosuvastatin and resolved upon discontinuation)

Reauthorization criteria

• According to prescriber, patient has experienced a response to therapy (e.g., decreasing LDL-C, total cholesterol, non-HDL-C, or apolipoprotein B)

Approval duration

1 year