Amarin Corp Plc (AMRN)

[HDGabor]

d-

It does not state >150 but <500 with PA

Prior Authorization/Medical Necessity

1. Initial Authorization

a. Vascepa will be approved based on all of the following criteria:

1) Moderate hypertriglyceridemia (pre-treatment triglyceride level 150 mg/dL to 499 mg/dL)

-AND-

Best,
G