Yorvipath (palopegteriparatide) — Blue Cross Blue Shield of Oklahoma

Initial criteria

• ALL of the following:
• 1. The member resides in Ohio AND
• 2. The plan is Fully Insured or HIM Shop (SG) AND
• 3. The patient does NOT have any FDA labeled contraindications to the requested agent AND
• 4. ONE of the following:
• A. The patient has another FDA labeled indication for the requested agent and route of administration OR
• B. The patient has another indication that is supported in compendia for the requested agent and route of administration OR
• C. The prescriber has submitted TWO articles from major peer-reviewed professional medical journals supporting the proposed use(s) as generally safe and effective
• Non-oncology compendia allowed: DrugDex level 1, 2A or 2B, AHFS-DI (narrative supportive)
• Oncology compendia allowed: NCCN 1 or 2A, AHFS-DI (narrative supportive), DrugDex level 1, 2A, or 2B, Clinical Pharmacology (supportive), LexiDrugs evidence level A, peer-reviewed literature

Approval duration

36 months (BCBSOK); 12 months (other plans)