Eohilia — Blue Cross Blue Shield of Montana
other FDA labeled or compendia-supported indications (Ohio members, fully insured or HIM Shop plans)
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
- Patient has no FDA labeled contraindications
- ONE of the following: (A) another FDA labeled indication for the requested agent/route OR (B) another indication supported in compendia (non-oncology: DrugDex 1, 2A, or 2B; AHFS-DI supportive; oncology: NCCN 1 or 2A, AHFS-DI supportive, DrugDex 1, 2A, or 2B, Clinical Pharmacology supportive, LexiDrugs level A, or peer-reviewed medical literature) OR (C) prescriber submitted two peer-reviewed journal articles from major medical journals supporting proposed use as generally safe and effective (case studies not acceptable)
Approval duration
12 months