Plozasiran (Redemplo) (CPB 1096)

IMMEDIATELY: Billing and provider relations teams must implement the following: (1) Establish precertification process for all plozasiran (Redemplo) claims by contacting Aetna GCIT team at (866) 752-7021 or fax (888) 267-3277 before claim submission; (2) Update billing software to flag any plozasiran claims and require documented precertification authorization number prior to processing; (3) Notify prescribing providers (cardiologists, endocrinologists, lipid specialists, geneticists, or FCS specialists) that plozasiran requires precertification and requires submission of Statement of Medical Necessity (SMN) form via Specialty Pharmacy Precertification process; (4) Establish internal checklist to verify all initial approval criteria are met before claim submission: confirmed FCS diagnosis (genetic testing OR NAFCS score ≥45 OR Moulin score ≥10), fasting triglycerides ≥880 mg/dL, patient on very-low-fat diet (≤20-30g total fat/day), and no concurrent olezarsen (Tryngolza) use; (5) For reauthorization requests, verify documented positive clinical response (TG reduction or reduced pancreatitis episodes) and continued dietary compliance; (6) Implement tracking mechanism to ensure no claims are submitted with concurrent billing of olezarsen, as this is a coverage exclusion. Failure to obtain precertification will result in claim denials. Document all precertification numbers in patient record for appeal purposes.