Resmetirom — Blue Cross Blue Shield of Alabama
other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Reauthorization criteria
- The patient will continue the weight management regimen in combination with the requested agent OR the patient has a diagnosis other than noncirrhotic nonalcoholic steatohepatitis (NASH) or metabolic dysfunction associated steatohepatitis (MASH)
- AND the patient has had clinical benefit with the requested agent
- AND the patient does NOT have ANY of the following: decompensated cirrhosis; moderate to severe hepatic impairment (Child-Pugh Class B or C); any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
- AND the prescriber is a specialist in the area of the patient’s diagnosis (e.g., hepatologist, gastroenterologist) or has consulted with a specialist
- AND the patient does NOT have any FDA labeled contraindications to the requested agent
Approval duration
12 months