Hepatitis C Agents (new) — Blue Cross Blue Shield of New Mexico
Hepatitis C virus infection (new agents per FDA labeling)
Initial criteria
- Requested length of therapy does NOT exceed the length of therapy noted in Table 11 (FDA labeling) for the patient’s treatment regimen
- ONE of the following:
- A. The requested quantity (dose) does NOT exceed the program quantity limit OR
- B. BOTH of the following:
- 1. The requested quantity (dose) is greater than the program quantity limit AND
- 2. The requested quantity (dose) cannot be achieved with a lower quantity of a higher strength that does NOT exceed the program quantity limit
Approval duration
BCBSIL: 12 months; Others: up to duration per Table 11 (per FDA labeling)