CommercialPrior AuthMedium impact
Inclisiran (Leqvio®)
BCBS Tennessee·TN · Cardiology, Endocrinology, Family Medicine +1 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Inclisiran (Leqvio®) coverage that requires prior authorization with specific criteria for hypercholesterolemia and familial hypercholesterolemia treatment. The policy includes strict LDL-C level requirements, mandatory statin therapy trials, and specialist prescriber requirements.
Action Required
Before September 1, 2026: Billing team must update prior authorization procedures for Inclisiran (Leqvio®) prescriptions. Ensure providers document required LDL-C levels within 6 months, ASCVD history, statin therapy trials, and specialist consultation. Update encounter forms to capture genetic testing for HoFH diagnoses. Claims without proper prior authorization will be denied.