Traditional Medicaid

HHSC requires prior authorization for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor agents.  The Food and Drug Administration approved these products for use with diet and adjunct treatment with maximally-tolerated statin therapy in adults with familial hypercholesterolemia or those with atherosclerotic cardiovascular disease (ASCVD) whose low-density lipoprotein cholesterol (LDL-C) is not adequately maintained with the current available treatments. The American Heart Association and American College of Cardiology recommends lifestyle modifications including a healthy diet and physical exercise to improve LDL-C levels.

Prescribing providers complete and submit the PCSK9 Inhibitors Standard Prior Authorization Addendum (HHS Form 1355).  Approvals for are granted for six months.