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    Statins

    Drug - Statins

    June 2012

    Therapeutic Area - Cardiovascular

    Livalo (pivastatin) criteria

    • Patient has tried at least two of the following: simvastatin, fluvastatin, atorvastatin at equipotent dosing to the requested dose of pitavastatin without adequate cholesterol lowering OR
    • The patient has tried at least two of the following: simvastatin, fluvastatin, pravastatin, lovastatin, or rosuvastatin at equipotent dosing to the requested dose of pitavastatin and there was a confirmed drug-drug interaction which inhibited adequate cholesterol lowering

    Background information

    Statin Preferred Drug List - High Potency

    Preferred - atorvastatin-generic, simvastatin-generic

    Nonpreferred - Crestor (rosuvastatin), Lipitor (atorvastatin), Livalo (pitvastatin), Zocor (simvastatin)

    Statin Preferred Drug List - Low Potency

    Preferred - Lescol, Lescol XL, lovastatin-generic, pravastatin-generic

    Nonpreferred - Mevacor, Pravachol

    Equivalent Statin Dosing Chart

    Simvastatin
    (Zocor)    		 fluvastatin
    Lescol
    Lescol XL    		 Pravastatin
    (Pravachol)    		 Lovastatin
    (Mevacor)    		 Crestor
    (rosuvastatin)    		 (atorvastatin)
    Lipitor    		 Livalo
    (pitavastatin)
    Avail: 1, 2, 4 mg
    10 mg 40 mg 20 mg 20 mg [1 mg]
    20 mg 80 mg
    (Lescol XL)    		 40 mg 40 or 80 mg 5 or 10 mg 10 mg [2 mg]
    40 mg 80 mg 80 mg 20 mg [4 mg]
    80 mg 40 mg
    20 mg 80 mg
    40 mg

     [Livalo comparative potency based on head-to-head trial data with pravastatin, head-to-head with atorvastatin and head-to-head trial data with simvastatin]

    Statins are also subject to quantity limit restrictions.

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

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