Verkazia — Blue Cross Blue Shield of Montana

Initial criteria

• Member resides in Ohio
• Plan is Fully Insured or HIM Shop (SG)
• Patient does NOT have any FDA labeled contraindications to the requested agent
• 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 that is supported in compendia for the requested agent and route of administration OR (c) Prescriber has submitted TWO articles from major peer‑reviewed professional medical journals supporting the proposed use(s) as generally safe and effective

Approval duration

12 months