Retacrit — Blue Cross Blue Shield of New Mexico

Rare diseases for BCBS NM fully insured or NM HIM members or Ohio fully insured/HIM Shop members

Initial criteria

Patient does not have FDA labeled contraindications
Requested indication is a rare disease
One of the following: patient has another FDA labeled indication, an indication supported in compendia, OR prescriber submitted two peer-reviewed clinical journal articles supporting off-label use
Non-oncology compendia allowed: DrugDex level 1, 2A or 2B, AHFS-DI supportive text; Oncology compendia allowed: NCCN 1 or 2A, AHFS-DI supportive text, DrugDex level 1, 2A, 2B, or Clinical Pharmacology supportive text, LexiDrugs level A, or peer-reviewed medical literature

12mo