Evinacumab-dgnb

Covers Evinacumab‑dgnb (Evkeeza) for treatment of homozygous familial hypercholesterolemia (HoFH) as an adjunct to other LDL‑C–lowering therapies. Coverage is limited to patients meeting policy‑specified clinical criteria—generally age ≥5 years—with genetic or clinical confirmation of HoFH and persistent elevated LDL‑C despite maximally tolerated combination lipid‑lowering therapy; use for heterozygous FH or other non‑HoFH causes is not covered, and off‑label uses require HHS‑adopted compendium support or two peer‑reviewed articles.

"Coverage of an FDA‑approved drug when prescribed for an off‑label use that is recognized as safe and effective in one or more standard medical reference compendia adopted by the U."

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