biologic immunomodulator agents — Blue Cross Blue Shield of Oklahoma

Initial criteria

• Has tried and had an inadequate response to ONE systemic corticosteroid (e.g., prednisone, methylprednisolone) after at least a 7-day duration OR intolerance/hypersensitivity to ONE corticosteroid OR
• FDA labeled contraindication to ALL systemic corticosteroids OR
• Medication history indicates use of another biologic immunomodulator labeled or supported for GCA