lonafarnib — Blue Cross Blue Shield of Illinois

Initial criteria

• The member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG) AND BOTH of the following:
• The patient does NOT have any FDA labeled contraindications to the requested agent AND ONE of the following:
• 1. The patient has another FDA labeled indication for the requested agent and route of administration OR
• 2. The patient has another indication that is supported in compendia for the requested agent and route of administration OR
• 3. The prescriber has submitted TWO articles from major peer-reviewed professional medical journals supporting the proposed use(s) as generally safe and effective (case studies not acceptable)

Approval duration

12 months