Praluent (alirocumab) — United Healthcare

Primary hyperlipidemia

Initial criteria

One of the following diagnoses: Primary hyperlipidemia OR Heterozygous familial hypercholesterolemia (HeFH) OR Atherosclerotic cardiovascular disease (ASCVD) (e.g., acute coronary syndromes, history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin)
Not used in combination with another proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor [e.g., Repatha (evolocumab)]
Not used in combination with Leqvio (inclisiran)

Documentation of positive clinical response to Praluent therapy
Not used in combination with another proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor [e.g., Repatha (evolocumab)]
Not used in combination with Leqvio (inclisiran)

12 months