“This is a great milestone in helping individuals with FH get the treatment they need to lower their cholesterol. We applaud UnitedHealthcare as this decision simplifies access for this largely invisible and misunderstood condition,” said Cat Davis Ahmed, vice president of policy and outreach for the FH Foundation.“The FH Foundation will continue to advocate on behalf of the 1.3 million Americans who have FH and will work together with insurers and policy makers on ways we can make appropriate treatments affordable and accessible for high-risk FH individuals.”
Prior authorization is an important step that assesses a number of criteria to identify patients who are appropriate candidates for the therapies, including personal and family medical history, previous use of statins and confirmation of benefits eligibility. By incorporating the newest clinical evidence into coverage criteria and making it easier to demonstrate the diagnosis of FH and previous intolerance to statins, UnitedHealthcare has greatly streamlined the prior authorization process and access to PCSK9 inhibitors for those who qualify to ensure treatment is provided to individuals for whom it is most indicated.