Camzyos — Blue Cross Blue Shield of Montana

Initial criteria

• 1. Member resides in Ohio AND
• 2. Plan is Fully Insured or HIM Shop (SG) AND BOTH of the following: A. Patient does NOT have any FDA labeled contraindications to the requested agent AND B. 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 major peer-reviewed journal articles supporting the proposed use as generally safe and effective

Approval duration

12 months