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    Myalept

    Drug - Myalept™ (metreleptin) [Amylin Pharmaceuticals, LLC]  

    November 2014

    Therapeutic area - Leptin hormone analogs

    Approval criteria

    • Patient must have leptin deficiency. Include a copy of leptin assay results with the prior authorization request AND
    • Patient must have congenital or acquired primary lipodystrophy AND EITHER
    • A diagnosis of type 2 diabetes OR
    • Triglyceride levels above 500mg/dL

    Denial criteria

    • Diagnosis of HIV/HIV-related lipodystrophy
    • Diagnosis of liver disease
    • General obesity not associated with congenital leptin deficiency

    Quantity limit

    Maximum daily dose is 10 mg.

    Questions?

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

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