Zilbrysq — Blue Cross Blue Shield of Oklahoma

Initial criteria

• 1. Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
• 2. No FDA labeled contraindications to requested agent
• 3. ONE of the following:
•   • Patient has another FDA labeled indication for the requested agent and route OR
•   • Patient has indication supported in compendia (DrugDex level 1, 2A, 2B; AHFS-DI supportive text) OR
•   • Prescriber has submitted two major peer-reviewed journal articles (JAMA, NEJM, Lancet) showing safety and efficacy with accepted study designs (not case studies)
• 4. Compendia accepted for oncology: NCCN 1 or 2A, AHFS-DI supportive, DrugDex level 1, 2A, 2B, Clinical Pharmacology supportive, or Lexi-Drugs level A
• 5. Non-oncology compendia accepted: DrugDex level 1, 2A, 2B, AHFS-DI supportive

Approval duration

12 months