Limited Use Note(s)

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Reason For Use CodeClinical Criteria
380For use in combination with a HMG-CoA reductase inhibitor ('statin') in patients with hypercholesterolemia who have not reached target LDL levels despite the use of maximally tolerated doses.
LU Authorization Period: Indefinite.
381For use as monotherapy in the management of hypercholesterolemia in patients who are intolerant to HMG-CoA reductase inhibitors or where HMG-CoA reductase inhibitors are contraindicated.
LU Authorization Period: Indefinite.