All PlansPrior AuthLow impact
Evinacumab-dgnb (Evkeeza™)
BCBS Tennessee·TN · Cardiology, Endocrinology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New policy establishes coverage criteria for Evinacumab-dgnb (Evkeeza™) for treating homozygous familial hypercholesterolemia in patients 1+ years old. Policy requires prior authorization with genetic testing confirmation and specific specialist prescribing requirements.
Action Required
Before July 31, 2026: Review policy to understand prior authorization requirements for Evkeeza™. Ensure cardiologists, endocrinologists, lipid specialists, and geneticists are aware of coverage criteria including genetic testing documentation, LDL-C levels, and maximally tolerated lipid therapy requirements. Update prior auth workflows if practice treats HoFH patients.