Rivfloza (nedosiran sodium) — Blue Cross Blue Shield of Montana
Quantity limit exception
Initial criteria
- Requested quantity (dose) does NOT exceed program quantity limit OR
- Requested quantity (dose) exceeds limit AND ONE of the following: A. (1) Requested agent does NOT have a maximum FDA labeled dose for indication AND (2) There is support for higher dose OR B. (1) Requested quantity does NOT exceed maximum FDA labeled dose AND (2) There is support for why dose cannot be achieved with lower quantity of higher strength
Approval duration
12 months (BCBSIL); 6 months others initial; 12 months renewal