Sevenfact — Blue Cross Blue Shield of Montana

Initial criteria

• The member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG)
• The patient does NOT have any FDA labeled contraindications to Sevenfact
• ONE of the following: (A) patient has another FDA labeled indication for the requested agent and route of administration OR (B) patient has another indication supported in compendia (DrugDex level 1, 2A, or 2B; AHFS-DI, NCCN 1 or 2A, etc.) for Sevenfact and route of administration OR (C) prescriber submitted TWO articles from major peer-reviewed journals supporting the proposed use(s) as generally safe and effective

Approval duration

12 months