Ezallor Sprinkle (rosuvastatin) — Blue Cross Blue Shield of Kansas
FDA labeled indications for lowering LDL-C or reducing cardiovascular risk as outlined for each statin product
Preferred products
- Any generic statin
- Statin combination
Initial criteria
- 1. The patient has ONE of the following:
- A. A medication history of use in the past 90 days to ONE prerequisite agent OR
- B. An intolerance or hypersensitivity to ONE prerequisite agent that is NOT expected to occur with the requested agent OR
- C. An FDA labeled contraindication to ALL prerequisite agents that is NOT expected to occur with the requested agent
Approval duration
12 months