Tarpeyo — Blue Cross Blue Shield of New Mexico

Initial criteria

• Requested quantity (dose) does NOT exceed the program quantity limit OR
• Requested quantity (dose) exceeds the program quantity limit AND ONE of the following: (A) Requested agent has no maximum FDA labeled dose for indication AND support for higher dose OR (B) Requested quantity does not exceed maximum FDA labeled dose AND justification why cannot achieve with lower quantity of higher strength within limit OR (C) Requested quantity exceeds maximum FDA labeled dose AND support for higher dose for indication

Approval duration

10–12 months