Skyclarys — Blue Cross Blue Shield of Montana

Initial criteria

• Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
• Patient does NOT have any FDA labeled contraindications to the requested agent
• ONE of the following: (1) patient has another FDA labeled indication for the requested agent and route of administration OR (2) patient has another compendia-supported indication for the requested agent and route of administration OR (3) prescriber has submitted TWO peer-reviewed journal articles supporting the proposed use as generally safe and effective (e.g., JAMA, NEJM, Lancet)

Approval duration

12 months