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Mavenclad (cladribine) — Blue Cross Blue Shield of New Mexico

Multiple sclerosis (off-label use for Ohio members)

Initial criteria

  • The member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG)
  • The patient does NOT have any FDA labeled contraindications to the requested agent
  • ONE of the following (text beyond this portion likely specifies additional criteria not shown here)