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Qbrexza — Blue Cross Blue Shield of Illinois

non-oncology compendia use (for members residing in Ohio, Fully Insured or HIM Shop)

Initial criteria

  • Member resides in Ohio
  • 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: (A) patient has another FDA labeled indication for the requested agent and route of administration OR (B) patient has another indication supported in compendia for the requested agent and route OR (C) prescriber submitted TWO articles from major peer-reviewed medical journals supporting proposed use as generally safe and effective (case studies not acceptable)

Approval duration

12 months