biologic immunomodulator agents — Blue Cross Blue Shield of Illinois
members residing in Ohio (Fully Insured or HIM Shop)
Initial criteria
- Member resides in Ohio
- Plan is Fully Insured or HIM Shop (SG)
- Patient does not have any FDA‑labeled contraindications to the requested agent
- ONE of: patient has another FDA‑labeled indication for requested agent and route; or has another indication supported in compendia; or prescriber submitted two peer‑reviewed journal articles supporting proposed use as generally safe and effective (non‑oncology compendia: DrugDex 1, 2A, or 2B; AHFS-DI supportive narrative)
Approval duration
12 months