Repatha® (evolocumab)

Repatha (evolocumab) is covered for FDA‑approved uses—reducing major adverse CV events in adults with established CVD and as adjunct LDL‑C lowering therapy in primary hyperlipidemia, HeFH (≥10 years) and HoFH (≥10 years)—only when the policy's specified clinical, laboratory and documentation criteria are met; it is not covered if those criteria are not satisfied. Key requirements include age thresholds, prior trial of a high‑intensity statin (atorvastatin ≥40 mg or rosuvastatin ≥20 mg for ≥8 continuous weeks) with indication‑specific LDL‑C thresholds (≥55 mg/dL for established CVD; ≥70 mg/dL for HeFH/primary hyperlipidemia; HoFH: untreated >400 mg/dL or treated ≥300 mg/dL) or documented statin intolerance (rhabdomyolysis or muscle symptoms after separate trials of both atorvastatin and rosuvastatin), genetic/phenotypic confirmation for FH when indicated, documentation of response for re‑authorization, dosing limits, and 12‑month approvals.

"To reduce the risk of major adverse cardiovascular (CV) events (CV death, myocardial infarction, stroke, unstable angina requiring hospitalization, or coronary revascularization) in adults with est..."