Juxtapid (lomitapide) — United Healthcare

homozygous familial hypercholesterolemia (HoFH)

Preferred products

Diagnosis of homozygous familial hypercholesterolemia (HoFH) confirmed by one of the following: (1) submission of medical records confirming genetic confirmation of bi-allelic pathogenic/likely pathogenic variants on different chromosomes at the LDLR, APOB, PCSK9, or LDLRAP1 genes or ≥ 2 such variants at different loci OR (2) BOTH of the following: (a) untreated LDL-C > 400 mg/dL AND (b) one of the following: xanthoma before 10 years of age OR evidence of familial hypercholesterolemia in at least one parent
Patient is on a low-fat diet
Patient is receiving other lipid-lowering therapy (e.g., statin, ezetimibe, LDL apheresis)
Prescribed by a cardiologist OR endocrinologist OR lipid specialist
EITHER (1) BOTH of the following: (a) history of intolerance, failure or contraindication to Repatha (evolocumab) AND (b) history of intolerance, failure or contraindication to Evkeeza (evinacumab) OR (2) patient is currently on Juxtapid therapy
Not used in combination with a PCSK9 inhibitor [e.g., Praluent (alirocumab), Repatha (evolocumab)]
Not used in combination with Evkeeza (evinacumab-dgnb)

Patient is on a low-fat diet
Patient continues to receive other lipid-lowering therapy (e.g., statin, LDL apheresis)
Documentation of a positive clinical response to therapy from pre-treatment baseline
Prescribed by a cardiologist OR endocrinologist OR lipid specialist
Not used in combination with a PCSK9 inhibitor [e.g., Praluent (alirocumab), Repatha (evolocumab)]
Not used in combination with Evkeeza (evinacumab-dgnb)

12 months