Medium impact
Plozasiran (Redemplo) (CPB 1096, reviewed 12-2026-03)
Aetna·Effective Dec 3, 2026
Aetna has issued a new clinical policy (CPB 1096, effective 12-2026-03) establishing coverage criteria for plozasiran (Redemplo), a gene-based therapy for familial chylomicronemia syndrome (FCS) in commercial plans. The policy requires precertification, prescriber specialization (cardiology, endocrinology, lipid specialist, geneticist, or FCS specialist), specific diagnostic confirmation, fasting triglyceride thresholds ≥880 mg/dL, concurrent very-low-fat diet adherence, and prohibition of concurrent use with olezarsen (Tryngolza). All other indications are considered experimental.