Repatha
Example Question Scenarios
Summary: This logic checks the patient’s record for an active prescription for Repatha.
Parameters:
- Searches for the appropriate RxNorm code(s)
Summary: This logic checks the patient's record for an active prescription for a PCSK9 inhibitor. It verifies that the medication was active on the patient's medication list for at least 14 days prior to the PA Initiation Request. This assumes that the current request is for a continuation of existing therapy rather than a new start.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Filters for medications with the following status: active
- Excludes searching for records within the following number of days prior to the PA Initiation Request: 14
Summary: This logic checks the patient's record for an active alirocumab or inclisiran prescription.
Parameters:
- Searches for the following RxNorm ingredient code(s) andfor the appropriate RxNorm code(s).
- Filters for medications with the following status: active
Summary: This logic checks the patient's electronic health record for an active diagnosis of hyperlipidemia or atherosclerotic cardiovascular disease (ASCVD).
Answer Choice 1
Parameters:
- Searches for the following ICD-10 diagnosis code(s): E78.49, E78.2, E78.00, E78.5
- Searches for the following SNOMED code(s): 55822004
ICD-10
Code | Description |
|---|---|
E78.49 | Other hyperlipidemia |
E78.2 | Mixed hyperlipidemia |
E78.00 | Pure hypercholesterolemia, unspecified |
E78.5 | Hyperlipidemia, unspecified |
SNOMED CT
Code | Description |
|---|---|
55822004 | Hyperlipidemia (disorder) |
Answer Choice 2
Parameters:
- Searches for the following ICD-10 diagnosis code(s): I25*, I21*, I20.0, I20.1, I20.81, I63*, I67.9*, G45*, I73*, K55.0*, I51.9 (wildcard pattern)
- Searches for the following SNOMED code(s): 49601007, 53741008, 230690007, 266257000, 840580004, 62914000, 67362008, 233955003
ICD-10
I25* (56 codes)
Code | Description |
|---|---|
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris |
I25.111 | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm |
I25.112 | Atherosclerotic heart disease of native coronary artery with refractory angina pectoris |
I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris |
I25.119 | Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris |
I25.2 | Old myocardial infarction |
I25.3 | Aneurysm of heart |
I25.41 | Coronary artery aneurysm |
I25.42 | Coronary artery dissection |
I25.5 | Ischemic cardiomyopathy |
I25.6 | Silent myocardial ischemia |
I25.700 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris |
I25.701 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm |
I25.702 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris |
I25.708 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris |
I25.709 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris |
I25.710 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris |
I25.711 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm |
I25.712 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris |
I25.718 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris |
I25.719 | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris |
I25.720 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris |
I25.721 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm |
I25.722 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris |
I25.728 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris |
I25.729 | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris |
I25.730 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris |
I25.731 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm |
I25.732 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris |
I25.738 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris |
I25.739 | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris |
I25.750 | Atherosclerosis of native coronary artery of transplanted heart with unstable angina |
I25.751 | Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm |
I25.752 | Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris |
I25.758 | Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris |
I25.759 | Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris |
I25.760 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina |
I25.761 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm |
I25.762 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris |
I25.768 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris |
I25.769 | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris |
I25.790 | Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris |
I25.791 | Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm |
I25.792 | Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris |
I25.798 | Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris |
I25.799 | Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris |
I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris |
I25.811 | Atherosclerosis of native coronary artery of transplanted heart without angina pectoris |
I25.812 | Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris |
I25.82 | Chronic total occlusion of coronary artery |
I25.83 | Coronary atherosclerosis due to lipid rich plaque |
I25.84 | Coronary atherosclerosis due to calcified coronary lesion |
I25.85 | Chronic coronary microvascular dysfunction |
I25.89 | Other forms of chronic ischemic heart disease |
I25.9 | Chronic ischemic heart disease, unspecified |
I21* (13 codes)
Code | Description |
|---|---|
I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery |
I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery |
I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall |
I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery |
I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall |
I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery |
I21.29 | ST elevation (STEMI) myocardial infarction involving other sites |
I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site |
I21.4 | Non-ST elevation (NSTEMI) myocardial infarction |
I21.9 | Acute myocardial infarction, unspecified |
I21.A1 | Myocardial infarction type 2 |
I21.A9 | Other myocardial infarction type |
I21.B | Myocardial infarction with coronary microvascular dysfunction |
I63* (91 codes)
Code | Description |
|---|---|
I63.00 | Cerebral infarction due to thrombosis of unspecified precerebral artery |
I63.011 | Cerebral infarction due to thrombosis of right vertebral artery |
I63.012 | Cerebral infarction due to thrombosis of left vertebral artery |
I63.013 | Cerebral infarction due to thrombosis of bilateral vertebral arteries |
I63.019 | Cerebral infarction due to thrombosis of unspecified vertebral artery |
I63.02 | Cerebral infarction due to thrombosis of basilar artery |
I63.031 | Cerebral infarction due to thrombosis of right carotid artery |
I63.032 | Cerebral infarction due to thrombosis of left carotid artery |
I63.033 | Cerebral infarction due to thrombosis of bilateral carotid arteries |
I63.039 | Cerebral infarction due to thrombosis of unspecified carotid artery |
I63.09 | Cerebral infarction due to thrombosis of other precerebral artery |
I63.10 | Cerebral infarction due to embolism of unspecified precerebral artery |
I63.111 | Cerebral infarction due to embolism of right vertebral artery |
I63.112 | Cerebral infarction due to embolism of left vertebral artery |
I63.113 | Cerebral infarction due to embolism of bilateral vertebral arteries |
I63.119 | Cerebral infarction due to embolism of unspecified vertebral artery |
I63.12 | Cerebral infarction due to embolism of basilar artery |
I63.131 | Cerebral infarction due to embolism of right carotid artery |
I63.132 | Cerebral infarction due to embolism of left carotid artery |
I63.133 | Cerebral infarction due to embolism of bilateral carotid arteries |
I63.139 | Cerebral infarction due to embolism of unspecified carotid artery |
I63.19 | Cerebral infarction due to embolism of other precerebral artery |
I63.20 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries |
I63.211 | Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery |
I63.212 | Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery |
I63.213 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries |
I63.219 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery |
I63.22 | Cerebral infarction due to unspecified occlusion or stenosis of basilar artery |
I63.231 | Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries |
I63.232 | Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries |
I63.233 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries |
I63.239 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery |
I63.29 | Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries |
I63.30 | Cerebral infarction due to thrombosis of unspecified cerebral artery |
I63.311 | Cerebral infarction due to thrombosis of right middle cerebral artery |
I63.312 | Cerebral infarction due to thrombosis of left middle cerebral artery |
I63.313 | Cerebral infarction due to thrombosis of bilateral middle cerebral arteries |
I63.319 | Cerebral infarction due to thrombosis of unspecified middle cerebral artery |
I63.321 | Cerebral infarction due to thrombosis of right anterior cerebral artery |
I63.322 | Cerebral infarction due to thrombosis of left anterior cerebral artery |
I63.323 | Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries |
I63.329 | Cerebral infarction due to thrombosis of unspecified anterior cerebral artery |
I63.331 | Cerebral infarction due to thrombosis of right posterior cerebral artery |
I63.332 | Cerebral infarction due to thrombosis of left posterior cerebral artery |
I63.333 | Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries |
I63.339 | Cerebral infarction due to thrombosis of unspecified posterior cerebral artery |
I63.341 | Cerebral infarction due to thrombosis of right cerebellar artery |
I63.342 | Cerebral infarction due to thrombosis of left cerebellar artery |
I63.343 | Cerebral infarction due to thrombosis of bilateral cerebellar arteries |
I63.349 | Cerebral infarction due to thrombosis of unspecified cerebellar artery |
I63.39 | Cerebral infarction due to thrombosis of other cerebral artery |
I63.40 | Cerebral infarction due to embolism of unspecified cerebral artery |
I63.411 | Cerebral infarction due to embolism of right middle cerebral artery |
I63.412 | Cerebral infarction due to embolism of left middle cerebral artery |
I63.413 | Cerebral infarction due to embolism of bilateral middle cerebral arteries |
I63.419 | Cerebral infarction due to embolism of unspecified middle cerebral artery |
I63.421 | Cerebral infarction due to embolism of right anterior cerebral artery |
I63.422 | Cerebral infarction due to embolism of left anterior cerebral artery |
I63.423 | Cerebral infarction due to embolism of bilateral anterior cerebral arteries |
I63.429 | Cerebral infarction due to embolism of unspecified anterior cerebral artery |
I63.431 | Cerebral infarction due to embolism of right posterior cerebral artery |
I63.432 | Cerebral infarction due to embolism of left posterior cerebral artery |
I63.433 | Cerebral infarction due to embolism of bilateral posterior cerebral arteries |
I63.439 | Cerebral infarction due to embolism of unspecified posterior cerebral artery |
I63.441 | Cerebral infarction due to embolism of right cerebellar artery |
I63.442 | Cerebral infarction due to embolism of left cerebellar artery |
I63.443 | Cerebral infarction due to embolism of bilateral cerebellar arteries |
I63.449 | Cerebral infarction due to embolism of unspecified cerebellar artery |
I63.49 | Cerebral infarction due to embolism of other cerebral artery |
I63.50 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery |
I63.511 | Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery |
I63.512 | Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery |
I63.513 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries |
I63.519 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery |
I63.521 | Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery |
I63.522 | Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery |
I63.523 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries |
I63.529 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery |
I63.531 | Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery |
I63.532 | Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery |
I63.533 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries |
I63.539 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery |
I63.541 | Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery |
I63.542 | Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery |
I63.543 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries |
I63.549 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery |
I63.59 | Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery |
I63.6 | Cerebral infarction due to cerebral venous thrombosis, nonpyogenic |
I63.81 | Other cerebral infarction due to occlusion or stenosis of small artery |
I63.89 | Other cerebral infarction |
I63.9 | Cerebral infarction, unspecified |
I67.9* (1 codes)
Code | Description |
|---|---|
I67.9 | Cerebrovascular disease, unspecified |
G45* (7 codes)
Code | Description |
|---|---|
G45.0 | Vertebro-basilar artery syndrome |
G45.1 | Carotid artery syndrome (hemispheric) |
G45.2 | Multiple and bilateral precerebral artery syndromes |
G45.3 | Amaurosis fugax |
G45.4 | Transient global amnesia |
G45.8 | Other transient cerebral ischemic attacks and related syndromes |
G45.9 | Transient cerebral ischemic attack, unspecified |
I73* (6 codes)
Code | Description |
|---|---|
I73.00 | Raynaud's syndrome without gangrene |
I73.01 | Raynaud's syndrome with gangrene |
I73.1 | Thromboangiitis obliterans [Buerger's disease] |
I73.81 | Erythromelalgia |
I73.89 | Other specified peripheral vascular diseases |
I73.9 | Peripheral vascular disease, unspecified |
K55.0* (18 codes)
Code | Description |
|---|---|
K55.011 | Focal (segmental) acute (reversible) ischemia of small intestine |
K55.012 | Diffuse acute (reversible) ischemia of small intestine |
K55.019 | Acute (reversible) ischemia of small intestine, extent unspecified |
K55.021 | Focal (segmental) acute infarction of small intestine |
K55.022 | Diffuse acute infarction of small intestine |
K55.029 | Acute infarction of small intestine, extent unspecified |
K55.031 | Focal (segmental) acute (reversible) ischemia of large intestine |
K55.032 | Diffuse acute (reversible) ischemia of large intestine |
K55.039 | Acute (reversible) ischemia of large intestine, extent unspecified |
K55.041 | Focal (segmental) acute infarction of large intestine |
K55.042 | Diffuse acute infarction of large intestine |
K55.049 | Acute infarction of large intestine, extent unspecified |
K55.051 | Focal (segmental) acute (reversible) ischemia of intestine, part unspecified |
K55.052 | Diffuse acute (reversible) ischemia of intestine, part unspecified |
K55.059 | Acute (reversible) ischemia of intestine, part and extent unspecified |
K55.061 | Focal (segmental) acute infarction of intestine, part unspecified |
K55.062 | Diffuse acute infarction of intestine, part unspecified |
K55.069 | Acute infarction of intestine, part and extent unspecified |
SNOMED CT
Code | Description |
|---|---|
49601007 | Disorder of cardiovascular system (disorder) |
53741008 | Coronary arteriosclerosis (disorder) |
230690007 | Cerebrovascular accident (disorder) |
266257000 | Transient ischemic attack (disorder) |
840580004 | Peripheral arterial disease (disorder) |
62914000 | Cerebrovascular disease (disorder) |
67362008 | Aortic aneurysm (disorder) |
233955003 | Abdominal aortic atherosclerosis (disorder) |
Summary: This logic checks the patient's record for an active diagnosis of atherosclerotic heart disease of a native coronary artery (coronary arteriosclerosis).
Parameters:
- Searches for the following ICD-10 diagnosis code(s): I25.1*, I25.82, I25.83 (wildcard pattern)
- Searches for the following SNOMED code(s): 53741008
ICD-10
Code | Description |
|---|---|
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris |
I25.111 | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm |
I25.112 | Atherosclerotic heart disease of native coronary artery with refractory angina pectoris |
I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris |
I25.119 | Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris |
I25.82 | Chronic total occlusion of coronary artery |
I25.83 | Coronary atherosclerosis due to lipid rich plaque |
SNOMED CT
Code | Description |
|---|---|
53741008 | Coronary arteriosclerosis (disorder) |
Summary: This logic checks if the patient has been on a high-intensity statin (atorvastatin 40 mg+ or rosuvastatin 20 mg+) AND ezetimibe at least 60 days coverage over the past 20 years (atorvastatin 40mg+ or rosuvastatin 20mg+) AND at least 60 days of coverage for ezetimibe.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Evaluates for this minimum total number of days specified medications (based on RxCUI) are active on the medication list: 60
- Evaluates this number of days in the past for active medication validity (written) dates: 7300
Summary: This logic checks the patient’s record for a history of high-intensity statin therapy (atorvastatin 40 mg+ or rosuvastatin 20 mg+).
Parameters:
- Searches for the appropriate RxNorm code(s).
- Filters for medications with the following status: active, stopped, completed
Question: Does the patient's low-density lipoprotein cholesterol (LDL-C) level after this treatment regimen remain greater than or equal to 70 mg/dL?
Summary: This logic identifies patients with an LDL-C lab result greater than or equal to 70 mg/dL.
Parameters:
- Confirms value is greater than or equal to: 55
- Searches for the following LOINC code(s): 2089-1, 13457-7, 18262-6, 39469-2
- Uses the following unit of measurement: mg/dL
LOINC
Code | Description |
|---|---|
2089-1 | Cholesterol in LDL [Mass/volume] in Serum or Plasma |
13457-7 | Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation |
18262-6 | Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay |
39469-2 | Cholesterol in LDL [Moles/volume] in Serum or Plasma by calculation |
Summary: This logic identifies patients with an LDL-C lab result greater than or equal to 55 mg/dL.
Parameters:
- Confirms value is greater than or equal to: 55
- Searches for the following LOINC code(s): 2089-1, 13457-7, 18262-6, 39469-2
- Uses the following unit of measurement: mg/dL
LOINC
Code | Description |
|---|---|
2089-1 | Cholesterol in LDL [Mass/volume] in Serum or Plasma |
13457-7 | Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation |
18262-6 | Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay |
39469-2 | Cholesterol in LDL [Moles/volume] in Serum or Plasma by calculation |
Refer to the REPATHA® Prescribing Information for complete product details, including indications, dosing, contraindications, warnings, and adverse reactions.