Crenessity — Blue Cross Blue Shield of Illinois

rare disease indications (BCBS NM Fully Insured or NM HIM, or Ohio Fully Insured/HIM Shop members)

Initial criteria

For BCBS NM Fully Insured or NM HIM members: The patient does NOT have any FDA labeled contraindications to the requested agent AND the requested indication is a rare disease AND ONE of the following: the patient has another FDA labeled indication for the requested agent and route of administration OR the patient has another indication supported in compendia for the requested agent and route of administration
For Ohio Fully Insured or HIM Shop (SG) members: The member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG) AND the patient does NOT have any FDA labeled contraindications to the requested agent AND ONE of the following: the patient has another FDA labeled indication for the requested agent and route of administration OR the patient has another indication that is supported in compendia for the requested agent and route of administration OR the prescriber has submitted TWO peer-reviewed journal articles supporting the proposed use as generally safe and effective (non-oncology compendia allowed: DrugDex level 1, 2A or 2B, AHFS-DI; oncology compendia allowed: NCCN 1 or 2A, AHFS-DI, DrugDex level 1, 2A, or 2B, Clinical Pharmacology, LexiDrugs, or peer-reviewed medical literature)

12 months