Opzelura — Blue Cross Blue Shield of Illinois
other FDA labeled indications or compendia-supported indications (Ohio members)
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
- Patient does NOT have any FDA labeled contraindications
- ONE of the following: patient has another FDA labeled indication and route OR indication supported in compendia for requested agent OR prescriber submitted two peer-reviewed journal articles supporting safety and efficacy (case studies not acceptable)
- Non-oncology compendia allowed: DrugDex level 1,2A,2B; AHFS-DI supportive narrative; Oncology compendia allowed: NCCN 1 or 2A, AHFS-DI supportive narrative; DrugDex 1,2A,2B; Clinical Pharmacology supportive narrative; LexiDrugs evidence level A
Approval duration
12 months