Hysingla er — Blue Cross Blue Shield of Oklahoma

Initial criteria

• Requested agent is eligible for continuation of therapy AND prescriber states patient has been treated with the requested agent within the past 90 days AND is at risk if therapy is changed OR
• Patient has diagnosis of chronic cancer pain due to an active malignancy OR
• Patient is enrolled in hospice program or meets hospice criteria for life expectancy of ≤ 6 months OR
• Prescriber is requesting palliative care or compassionate use where benefits of pain relief and patient comfort outweigh opioid risks OR
• Patient has diagnosis of sickle cell anemia OR
• Patient is undergoing treatment of chronic non-cancer pain AND ALL of the following apply: ONE of the following: BOTH of the following: ONE of the following: (criteria continue beyond current chunk)