Wakix — Blue Cross Blue Shield of Illinois
other FDA labeled or compendia supported indications or peer-reviewed evidence-based uses (Ohio members)
Initial criteria
- 1. The member resides in Ohio AND
- 2. The plan is Fully Insured or HIM Shop (SG) AND BOTH of the following: A. The patient does NOT have any FDA labeled contraindications to the requested agent AND B. ONE of the following: 1. The patient has another FDA labeled indication and route of administration OR 2. The patient has another indication supported in compendia (DrugDex level 1, 2A, 2B; AHFS-DI supportive narrative; NCCN 1 or 2A; Clinical Pharmacology supportive; Lexi-Drugs A) OR 3. The prescriber has submitted two peer-reviewed professional medical journal articles supporting proposed use as safe and effective
Approval duration
12 months