Nexlizet — Medical Mutual

Established Cardiovascular Disease

Initial criteria

Patient is age ≥ 18 years; AND
Patient has had one of the following conditions or diagnoses: previous myocardial infarction or history of an acute coronary syndrome; OR angina (stable or unstable); OR past history of stroke or transient ischemic attack; OR coronary artery disease; OR peripheral arterial disease; OR patient has undergone a coronary or other arterial revascularization procedure in the past; AND
Patient meets one of the following criteria: has tried one high-intensity statin therapy (atorvastatin ≥ 40 mg daily; rosuvastatin ≥ 20 mg daily) for ≥ 8 continuous weeks AND LDL-C level after therapy remains ≥ 55 mg/dL; OR patient has been determined to be statin intolerant by either (1) experiencing statin-related rhabdomyolysis OR (2) having skeletal-related muscle symptoms that occurred on both atorvastatin and rosuvastatin and resolved after discontinuation

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

1 year