Generated from latest updates
Two payers published first-ever Dawnzera policy this week — both landed with step therapy against Takhzyro. Tryngolza (sHTG) gained a favorable TG-threshold simplification at Aetna; FCS genetic-testing criteria still needs source confirmation at three plans.
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6 latest updates match your saved context.
Upcoming effective dates
8 of 8 sourced policy records from published payer documents
UnitedHealthcare · National
Listed on UnitedHealthcare's Prior Authorization / Medical Necessity required drug list for commercial plans. Specific clinical criteria not captured in this summary — pull the full policy document for detail.
Authorization duration: Not specified in summary
Alaska Medicaid · Alaska
State-specific PA criteria document published; detail not fully captured in this summary — pull the full policy document.
Authorization duration: Not specified in summary
Aetna Better Health (Medicaid, multi-state) · Multi-state
Confirmed FCS diagnosis by genetic testing (biallelic pathogenic variants in LPL, GPIHBP1, APOA5, APOC2, LMF1, GPD1, or CREB3L3), or if genetic testing is inconclusive, a clinical diagnosis using Moulin or NAFCS scoring criteria.
Authorization duration: 6-12 months depending on state
Louisiana Medicaid · Louisiana
Confirmed HAE diagnosis, minimum age 12. Continuation requires documented positive response and confirmation the patient is not concurrently on another HAE prophylaxis medication.
Authorization duration: 12 months (initiation and continuation)
Centene · National
Fasting triglycerides >= 500 mg/dL required for the hypertriglyceridemia authorization bucket, separate from the FCS-specific genetic criteria (Coordinated Care, Medicaid MI - PEPP).
Authorization duration: Not specified in summary
CareSource (Marketplace, MI) · Michigan
Must be prescribed by or in consultation with an endocrinologist, cardiologist, or lipid specialist. Diagnosis of FCS confirmed by genetic test.
Authorization duration: 6 months initial
Cigna Healthcare · National
Prior authorization required. Initial approval requires prescribing by or in consultation with a specialist in the condition. Extensive documentation required (chart notes, labs, genetic test results).
Authorization duration: Not specified in summary
Wellmark BCBS · Iowa / South Dakota
Initial authorization of 6 months for FCS. Considered not medically necessary if criteria unmet. Manufacturer financial assistance program participation referenced as part of initial approval process.
Authorization duration: 6 months