Evkeeza® (Evinacumab-Dgnb) – Commercial Medical Benefit Drug Policyopen_in_new

Evkeeza is covered as an adjunct to other LDL‑C–lowering therapies for patients (≥5 years) with homozygous familial hypercholesterolemia who meet genetic confirmation or specific clinical diagnostic criteria, and it must not be used concurrently with lomitapide. Coverage requires lipid‑specialist involvement, documentation of prior/failed or intolerant therapy with maximally tolerated statins, ezetimibe and PCSK9 agents (or documented LDLR‑negative genotype, prior lomitapide/apheresis where applicable), FDA‑label dosing, initial/renewal authorizations up to 12 months, and proof of a positive clinical response for continuation.

"Evkeeza (evinacumab-dgnb) is proven and medically necessary for the treatment of homozygous familial hypercholesterolemia (HoFH) patients who meet all of the following criteria:"

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