ModifiedUnitedHealthcarePolicy 2025 P 3067-13

Step Therapy Praluent

Defines UnitedHealthcare step therapy requirements for coverage of Praluent (alirocumab) for hyperlipidemia (primary hyperlipidemia, HeFH, ASCVD) and homozygous familial hypercholesterolemia (HoFH), including required prior trial(s) of statin therapy and Repatha (evolocumab), authorization duration, and additional clinical rules.

Policy Summary

PayerUnitedHealthcare

PolicyStep Therapy Praluent

Policy CodePolicy 2025 P 3067-13

Change TypeClarification and pathway update

Effective DateAug 1, 2025

Next Review Date

Key ActionObtain prior authorization documenting required statin trials (duration, dose/intensity) and Repatha trial history (date and reason for failure/contraindication/intolerance) where applicable; authorizations are issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

Added Repatha (evolocumab) as required step prior to Praluent in many pathways (added 6/2021).

Added criterion for patients less than 10 years of age to align with new pediatric label (May 2024).

Clarified criterion for contraindication to statins (May 2025) without change to clinical intent.

Effective Date set to 8/1/2025 per header.

12 monthsAuthorization Duration

>=12 wksRequired statin trial length

Repatha requiredPrior biologic trial