Zenpep — Blue Cross Blue Shield of New Mexico

Initial criteria

• Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND BOTH:
• The patient does NOT have any FDA labeled contraindications to the requested agent AND
• ONE of the following:
• i. The patient has another FDA labeled indication for the requested agent and route of administration OR
• ii. The patient has another indication supported in compendia for the requested agent and route of administration OR
• iii. The prescriber has submitted TWO peer-reviewed journal articles supporting the proposed use as generally safe and effective (randomized, double blind, placebo controlled clinical trials; case studies not acceptable)

Approval duration

12 months