Cresemba (isavuconazole) — Blue Cross Blue Shield of Illinois

invasive mucormycosis

Reauthorization criteria

1. The patient has been previously approved for the requested agent through the plan’s Prior Authorization review process AND
2. ONE of the following:
A. BOTH of the following:
1. The patient has a diagnosis of invasive aspergillosis or invasive mucormycosis AND
2. The patient has continued indicators of active disease (e.g., biomarkers in serum assay, biopsy, microbiologic culture, radiographic evidence) OR
B. BOTH of the following:
1. The patient has a diagnosis other than invasive aspergillosis or invasive mucormycosis AND
2. There is support for continued use of the requested agent for the requested indication AND
3. The patient does NOT have any FDA labeled contraindications to the requested agent

6 months