Radicava ors starter kit — Blue Cross Blue Shield of Oklahoma
Other FDA labeled indication or compendia-supported indication
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
- No FDA labeled contraindications to the requested agent
- ONE of the following: another FDA labeled indication for requested agent and route; another compendia-supported indication; or prescriber submitted TWO peer-reviewed medical journal articles supporting proposed use as generally safe and effective (acceptable designs include randomized, double blind, placebo controlled clinical trials, not case studies)
Approval duration
12 months