Nexlizet — Medical Mutual

Primary Hyperlipidemia

Initial criteria

Patient is age ≥ 18 years; AND
Patient meets one of the following: coronary artery calcium/calcification score ≥ 300 Agatston units; OR patient has diabetes; AND
Patient meets one of the following: has tried one high-intensity statin therapy (atorvastatin ≥ 40 mg daily; rosuvastatin ≥ 20 mg daily) AND LDL-C level remains ≥ 70 mg/dL; OR has been determined to be statin intolerant by either (1) statin-related rhabdomyolysis OR (2) skeletal-related muscle symptoms 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