Rayos (prednisone delayed-release tablet) — Blue Cross Blue Shield of New Mexico

Initial criteria

• Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND both of the following:
• 1. Patient does NOT have any FDA labeled contraindications to the requested agent AND
• 2. 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 medical journals (e.g., JAMA, NEJM, Lancet) supporting the proposed use(s) as generally safe and effective (case studies not acceptable)

Approval duration

12 months