Rivfloza (nedosiran sodium) — Blue Cross Blue Shield of New Mexico

Initial criteria

• Requested quantity does NOT exceed the program quantity limit OR
• Requested quantity exceeds the program limit AND ONE of the following: (A) BOTH of the following: (1) The requested agent does NOT have a maximum FDA labeled dose for the requested indication AND (2) There is support for therapy with a higher dose OR (B) BOTH of the following: (1) Requested quantity does NOT exceed the maximum FDA labeled dose AND (2) There is justification why requested quantity cannot be achieved with a lower quantity of a higher strength within program limits

Approval duration

BCBSIL: 12 months; all others 6 months (initial), 12 months (renewal)