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Tryngolza (olezarsen) — Blue Cross Blue Shield of Oklahoma

use in Ohio for fully insured or HIM Shop (SG) plans with FDA-labeled or compendia-supported indications

Initial criteria

  • Member resides in Ohio
  • Plan is Fully Insured or HIM Shop (SG)
  • Patient has no FDA labeled contraindications to the requested agent
  • ONE of the following: (1) Patient has another FDA labeled indication and route OR (2) Patient has another compendia-supported indication and route OR (3) Prescriber submitted two peer-reviewed journal articles supporting proposed use as safe and effective (randomized, double blind, placebo controlled; case studies not acceptable)

Approval duration

12 months