leniolisib phosphate — Blue Cross Blue Shield of New Mexico

Initial criteria

• 1. Member resides in Ohio AND
• 2. The plan is Fully Insured or HIM Shop (SG) AND BOTH of the following: A. The patient does NOT have any FDA labeled contraindications to the requested agent AND B. ONE of the following: 1. The patient has another FDA labeled indication for the requested agent and route of administration OR 2. The patient has another indication that is supported in compendia for the requested agent and route of administration OR 3. The prescriber has submitted TWO peer-reviewed journal articles supporting the proposed use(s) as generally safe and effective. Accepted compendia: DrugDex level 1, 2A, or 2B; AHFS-DI (narrative supportive); NCCN 1 or 2A; Clinical Pharmacology (narrative supportive); LexiDrugs evidence level A.

Approval duration

12 months