requested opioid agent (any) — Blue Cross Blue Shield of Illinois

member resides in Ohio; plan is Fully Insured or HIM Shop (SG)

Initial criteria

Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND
Patient has no FDA labeled contraindication to requested agent AND ONE of the following:
Has FDA labeled indication for requested agent/route OR
Has compendia-supported indication for requested agent/route OR
Prescriber submitted two peer-reviewed journal articles (JAMA, NEJM, Lancet) supporting proposed use as generally safe and effective (case studies not acceptable; appropriate study designs required)

12 months