Cresemba (isavuconazole) — Blue Cross Blue Shield of Oklahoma
other FDA labeled indication
Initial criteria
- ONE of the following:
- • The patient has a diagnosis of invasive aspergillosis
- • The patient has a diagnosis of invasive mucormycosis
- • The patient has another FDA labeled indication for the requested agent and route of administration
- • The patient has another indication that is supported in compendia for the requested agent and route of administration
- AND The patient does NOT have any FDA labeled contraindications to the requested agent
- Compendia Allowed: AHFS or DrugDex 1, 2a, or 2b level of evidence
- Alternate approval for Ohio residents with Fully Insured or HIM Shop plans when no contraindication and either FDA labeled indication, compendia supported indication, or prescriber submitted two peer-reviewed journal articles supporting proposed use
Approval duration
6 months; Ohio cases 12 months