anastrozole — Blue Cross Blue Shield of Alabama

Initial criteria

• The requested breast cancer primary prevention agent is covered under the pharmacy benefit or has been approved through the coverage exception process
• There is support that the requested breast cancer primary prevention agent is medically necessary
• The patient is age ≥ 35 years
• The agent is requested for the primary prevention of breast cancer
• ONE of the following: The plan has not implemented a sex requirement OR The plan has implemented a sex requirement AND ONE of the following: The patient’s sex is female OR The requested agent is medically appropriate for the patient’s sex

Approval duration

12 months