ciclopirox — Blue Cross Blue Shield of Oklahoma

Initial criteria

• Member resides in Ohio AND
• Plan is Fully Insured or HIM Shop (SG) AND
• Patient does NOT have any FDA labeled contraindications to the requested agent AND
• ONE of the following: (1) Patient has another FDA labeled indication for requested agent and route of administration OR (2) Patient has another indication supported in compendia for requested agent and route of administration