tasimelteon oral suspension — Blue Cross Blue Shield of Illinois

Any indication when member resides in Ohio and plan is Fully Insured or HIM Shop (SG) and medical literature or compendia support use

Initial criteria

1. Member resides in Ohio
2. Plan is Fully Insured or HIM Shop (SG)
3. Patient does NOT have any FDA labeled contraindications to requested agent
4. ONE of the following:
A. Patient has another FDA labeled indication for requested agent and route of administration OR
B. Patient has another indication supported in compendia for requested agent and route of administration OR
C. Prescriber has submitted TWO peer-reviewed journal articles supporting proposed use as generally safe and effective (randomized, double-blind, placebo-controlled clinical trials; case studies not acceptable)

12 months