Nuedexta — Blue Cross Blue Shield of New Mexico

Initial criteria

• 1. The 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 as generally safe and effective (accepted designs include randomized, double-blind, placebo-controlled trials; case studies not acceptable)
• Non-oncology compendia allowed: DrugDex level 1, 2A, or 2B; AHFS-DI supportive narrative
• Oncology compendia allowed: NCCN 1 or 2A; AHFS-DI supportive narrative; DrugDex level 1, 2A, or 2B; Clinical Pharmacology or LexiDrugs supportive narrative; peer-reviewed medical literature

Approval duration

12 months