miglustat — Blue Cross Blue Shield of Illinois
Other FDA labeled or compendia supported, Ohio-specific plans
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND both:
- A. Patient has no FDA labeled contraindications AND
- B. ONE of: patient has other FDA labeled indication for agent and route; OR other indication supported in compendia; OR prescriber submits two peer-reviewed journal articles supporting safety and efficacy (JAMA, NEJM, Lancet, etc).
- Non-oncology compendia: DrugDex level 1, 2A, 2B; AHFS-DI supportive narrative.
- Oncology compendia: NCCN 1 or 2A; AHFS-DI supportive narrative; DrugDex level 1, 2A, 2B; Clinical Pharmacology supportive narrative; LexiDrugs evidence level A; peer-reviewed literature.
Reauthorization criteria
- Same location and plan requirements (Ohio, Fully Insured or HIM Shop (SG)).
- Patient previously approved and continues clinical benefit with requested agent.
Approval duration
12 months