Prior Authorization for Evkeeza

Effective Aug. 1, 2021, Harvard Pilgrim will require prior authorization for the medication Evkeeza (HCPCS code C9079: injection, evinacumab-dgnb, 5 mg) for members of our commercial plans.

Evkeeza is indicated as an adjunct to other low-density lipoprotein cholesterol lowering therapies for the treatment of adult and pediatric patients (aged 12 years and older) with homozygous familial hypercholesterolemia.

To request authorization, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).

For complete information — including coverage criteria for initial approval and continuation of therapy, limitations of use, required accompanying documentation, and FDA-approved maximum dosage and frequency limits — refer to Harvard Pilgrim’s commercial Evkeeza Medical Policy.

Publication Information

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Annmarie Dadoly,

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Production Coordinator