Prior Authorization

Statin Drugs for Treatment of High Blood Cholesterol

The statin step therapy program encourages the use of cost-effective, generic statins prior to the use of brand statins for the management of high blood cholesterol. The program approves coverage for a brand statin (including the combination agents Advicor, Simcor and Vytorin) when there is a history of generic statin use.

There are three generic statins available: lovastatin, pravastatin and simvastatin. Generic statin products cost significantly less than the brand products. The brand prescriptions affected by this program include Lipitor, Crestor, Vytorin, Simcor, Lescol XL, Advicor, Zocor, Lescol, Altoprev and Pravacol.

A prior authorization process will be available to ensure that patients who have been unable to tolerate the generic statin agent(s), or who have not had adequate response to one of these agents, have the option of treatment with another statin. This process allows for use of the brand agent if there is previous use of a generic that does not appear in claim history, or if the patient cannot use a generic due to allergy, intolerance, or contraindication. Brand agents may also be approved for use if the patient requires cholesterol lowering that cannot be achieved with available generic agents.

BCBSKS medical policy on Statin Step Therapy

 

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