Minolira — Blue Cross Blue Shield of Illinois
FDA labeled indication or compendia supported indication for the requested agent
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
- Patient does NOT have any FDA labeled contraindications to the requested agent
- ONE of the following: (A) Patient has another FDA labeled indication and route of administration OR (B) Patient has indication supported in compendia OR (C) Prescriber submitted two peer-reviewed journal articles supporting proposed use as generally safe and effective.
Approval duration
12 months (36 months for BCBSOK)