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Inclisiran (Leqvio®)
BCBS Tennessee·TN · Cardiology, Endocrinology, Internal Medicine +1 more·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy establishes prior authorization requirements for Inclisiran (Leqvio®) for cholesterol management, requiring specialist prescribing and specific documentation of LDL-C levels, ASCVD history, and statin therapy trials. The policy includes detailed coverage criteria based on cardiovascular risk and current cholesterol levels.
Action Required
Before July 31, 2026: Billing team must implement prior authorization requirements for Inclisiran (Leqvio®). Update system to require documentation of LDL-C levels within 6 months, ASCVD history or untreated LDL-C ≥190 mg/dL, and proof of statin therapy trial or contraindication. Ensure prescriptions come from cardiologist, endocrinologist, lipid specialist, or hypercholesterolemia specialist. Create workflow for 12-month authorization renewals with LDL-C reduction documentation.