Leqvio® (Inclisiran) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Leqvio (inclisiran) for adults with primary hyperlipidemia (including HeFH) or clinical ASCVD only when the patient has prior PCSK9 therapy OR ≥12 consecutive weeks of high‑intensity statin therapy (or documented statin intolerance), LDL‑C ≥55 mg/dL, is prescribed by a Cardiologist/Endocrinologist/Lipid specialist, is not receiving a PCSK9 inhibitor concurrently, and dosing follows FDA labeling with authorizations limited to 12 months. Initial and renewal authorizations require medical records (chart notes, labs) documenting prior treatments and reasons for discontinuation/intolerance, LDL‑C values, prescriber specialty, and for renewals evidence of a positive clinical response.

"Patient must have LDL-C greater than or equal to 55 mg/dL."

Sign up to see full coverage criteria, indications, and limitations.