Qbrexza — Blue Cross Blue Shield of Oklahoma
other FDA labeled indication or compendia-supported indication
Initial criteria
- Member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG)
- Patient does NOT have any FDA labeled contraindications to the requested agent
- ONE of the following: (1) patient has another FDA labeled indication for the requested agent and route of administration OR (2) patient has another indication supported in compendia for the requested agent and route of administration OR (3) prescriber has submitted TWO acceptable peer-reviewed journal articles supporting the proposed use as generally safe and effective
Approval duration
12 months