Ogsiveo — Blue Cross Blue Shield of Illinois
Desmoid tumors
Preferred products
- sorafenib (generic)
Initial criteria
- Patient must meet ALL general initial evaluation criteria
- Requested agent is non-preferred for specified indication; approval requires ONE of the following: current stable use; failure, intolerance, contraindication, or non-effectiveness of ONE preferred agent (sorafenib (generic)); NCCN support for requested agent; or medical necessity justification