Furoscix — Blue Cross Blue Shield of Kansas

Initial criteria

• Patient has a diagnosis of edema with chronic heart failure or chronic kidney disease (including nephrotic syndrome) AND BOTH of the following:
• • Patient was treated with an oral loop diuretic total daily dose of 40–160 mg furosemide equivalent
• • Patient will NOT be using the requested agent in combination with another loop diuretic and will transition back to oral diuretic therapy after completion of the requested agent
• OR patient has another FDA‑labeled indication for the requested agent and route of administration