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DrugMyalept™ (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.


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

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