Health Net
Vascepa (icosapent ethyl)
Drugs for the Heart : Drugs for Cholesterol
  • High Triglycerides:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Step Therapy: High Triglycerides:
    ST Multiple Generics

  • Prior Authorization: High Triglycerides:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes