Vascepa is a prescription medication used to reduce the risk of cardiovascular events in adults with elevated triglyceride levels. Prior authorization is required by most insurance companies before they cover the cost of Vascepa. The requirements for Vascepa pre-authorization vary depending on the insurance company and the specific plan.
According to the UnitedHealthcare Commercial Pharmacy Benefit Prior Authorization and Notification Program, prior authorization for Vascepa is required for all commercial plans [2]. The criteria for approval include a diagnosis of severe hypertriglyceridemia (triglyceride levels greater than or equal to 500 mg/dL) or mixed dyslipidemia (triglyceride levels greater than or equal to 150 mg/dL and less than or equal to 499 mg/dL with low-density lipoprotein cholesterol levels greater than or equal to 130 mg/dL) [2].
CareFirst BlueCross BlueShield also requires prior authorization for Vascepa [3]. The criteria for approval include a diagnosis of severe hypertriglyceridemia or mixed dyslipidemia with a documented trial and failure of at least two preferred generic medications [3].
Drug Patent Watch provides information on the patents and exclusivity for Vascepa but does not provide information on pre-authorization requirements [1].
In summary, prior authorization is required for Vascepa by most insurance companies. The specific criteria for approval vary depending on the insurance company and plan. Generally, a diagnosis of severe hypertriglyceridemia or mixed dyslipidemia is required, and in some cases, a trial and failure of other preferred medications may be necessary. Patients should consult with their healthcare provider and insurance company to determine the specific pre-authorization requirements for their plan.
Sources:
[1] https://www.drugpatentwatch.com/p/tradename/VASCEPA
[2] https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Notification-Vascepa.pdf
[3] https://provider.carefirst.com/carefirst-resources/provider/pdf/drug/Omega-3-Fatty-Acids-Criteria-exchange-only.pdf