Rivfloza (nedosiran sodium) — Blue Cross Blue Shield of Illinois

any indication when criteria met for rare disease or compendia/peer-reviewed support (NM Fully Insured or NM HIM member; or OH Fully Insured or HIM Shop member)

Initial criteria

For BCBS NM Fully Insured or NM HIM: ALL of the following: (A) no FDA labeled contraindications, (B) requested indication is a rare disease, AND ONE of the following: (1) another FDA labeled indication for the requested agent and route of administration OR (2) another indication supported in compendia for the agent and route of administration
For Ohio Fully Insured or HIM Shop members: ALL of the following: (A) no FDA labeled contraindications, AND ONE of the following: (1) another FDA labeled indication for the requested agent and route of administration OR (2) another indication supported in compendia OR (3) prescriber has submitted TWO articles from major peer-reviewed journals (JAMA, NEJM, Lancet) supporting the proposed use as generally safe and effective

Approval duration

12 months