requested opioid agent (any) — Blue Cross Blue Shield of Illinois
off-label indication supported by two peer-reviewed journal articles
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)
Approval duration
12 months