Tarpeyo — Blue Cross Blue Shield of Montana
off-label indication supported by peer-reviewed medical literature
Initial criteria
- Member resides in Ohio
 - Plan is Fully Insured or HIM Shop (SG)
 - No FDA labeled contraindications to Tarpeyo
 - The patient has another FDA labeled indication OR indication supported in compendia OR prescriber submitted two peer-reviewed journal articles supporting proposed use as generally safe and effective
 
Approval duration
12 months