Nuedexta — Blue Cross Blue Shield of Illinois

Initial criteria

• The member resides in Ohio
• The plan is Fully Insured or HIM Shop (SG)
• The patient does NOT have any FDA labeled contraindications to the requested agent
• ONE of the following:
• The patient has another FDA labeled indication for the requested agent and route of administration OR
• The patient has another indication that is supported in compendia for the requested agent and route of administration OR
• The prescriber has submitted TWO peer-reviewed journal articles (randomized, double-blind, placebo controlled clinical trials) supporting the requested use

Approval duration

12 months