Yorvipath (palopegteriparatide) — Blue Cross Blue Shield of New Mexico
All labeled indications (quantity limit exception criteria)
Initial criteria
- Requested quantity does NOT exceed program limit OR
- If exceeds limit: (A) no maximum FDA labeled dose AND support for higher dose OR (B) within FDA max dose AND justification why lower quantity of higher strength cannot meet dose OR (C) exceeds FDA max dose AND support for higher dose
Approval duration
12 months