Skyclarys — Blue Cross Blue Shield of New Mexico

Initial criteria

• Member resides in Ohio
• Plan is Fully Insured or HIM Shop (SG)
• Patient does NOT have any FDA labeled contraindications to the requested agent
• ONE of the following: (1) Patient has another FDA labeled indication for the requested agent and route of administration; OR (2) Patient has another indication supported in compendia for the requested agent and route of administration; OR (3) 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 (randomized, double-blind, placebo-controlled designs acceptable; case studies not acceptable)

Approval duration

12 months