MedicaidPrior AuthMedium impact
New Prior Authorization Request Form for PCSK9 Inhibitors
Connecticut Medicaid (HUSKY Health)·CT · Cardiology, Endocrinology, Family Medicine +1 more·Prior Authorization
Effective date
Feb 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY A, B, C, D) requires prior authorization for PCSK9 inhibitor medications (Praluent and Repatha) starting February 1, 2016. A new specific PA form must be used for all authorization requests for these cholesterol-lowering drugs.
Action Required
By February 1, 2016: Billing team must obtain prior authorization using the new PCSK9 Inhibitor PA Request Form before prescribing Praluent (alirocumab) or Repatha (evolocumab) for Connecticut Medicaid patients. Download the form from www.ctdssmap.com under Authorization/Certification Forms. Providers must verify patients meet criteria: age 18+, diagnosis of ASCVD/HeFH/HoFH, and failed high-intensity statin plus ezetimibe therapy for 3+ months. Claims will not be covered without proper prior authorization.