budesonide oral suspension 2 MG/10ML — Blue Cross Blue Shield of Texas
other FDA labeled or compendia supported indications (Ohio Fully Insured or HIM Shop plans)
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG).
- Patient does NOT have any FDA labeled contraindications to requested agent.
- ONE of the following: (A) patient has another FDA labeled indication for the requested agent and route of administration, OR (B) patient has another indication supported in compendia for requested agent and route, OR (C) prescriber has submitted TWO peer‑reviewed journal articles supporting proposed use as generally safe and effective (e.g., from JAMA, NEJM, or Lancet).
Approval duration
12 months