sacrosidase — Blue Cross Blue Shield of Illinois

Initial criteria

• Member resides in Ohio AND 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:
• 1. Patient has another FDA labeled indication for the requested agent and route of administration OR
• 2. Patient has another indication that is supported in compendia for the requested agent and route of administration OR
• 3. Prescriber has submitted TWO articles from major peer-reviewed professional medical journals supporting the proposed use(s) as generally safe and effective. Accepted study designs include randomized, double-blind, placebo-controlled clinical trials; case studies are not acceptable

Approval duration

12 months