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