lotilaner ophthalmic solution 0.25% — Blue Cross Blue Shield of Illinois
Other FDA labeled indications or compendia-supported indications (OH residents, Fully Insured or HIM Shop plans)
Initial criteria
- The member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND BOTH of the following:
- A. The patient does not have any FDA labeled contraindications to the requested agent AND
- B. 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 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 (e.g., JAMA, NEJM, Lancet) supporting the proposed use as generally safe and effective
Approval duration
12 months