Oxbryta (voxelotor) — Blue Cross Blue Shield of Alabama

Initial criteria

• - The patient has a diagnosis of sickle cell disease AND
• - If the patient has an FDA approved indication, then ONE of the following: • The patient’s age is within FDA labeling for the requested indication for the requested agent OR • There is support for using the requested agent for the patient’s age for the requested indication AND
• - ONE of the following: • The patient has tried and had an inadequate response after at least 6 months duration of therapy with maximally tolerated hydroxyurea OR • The patient has an intolerance or hypersensitivity to hydroxyurea OR • The patient has an FDA labeled contraindication to hydroxyurea