Cresemba (isavuconazole) — Blue Cross Blue Shield of Texas

invasive aspergillosis

Reauthorization criteria

Patient has been previously approved for requested agent through the plan’s Prior Authorization review process AND
ONE of the following:
A. BOTH of the following: 1. Patient has diagnosis of invasive aspergillosis or invasive mucormycosis AND 2. Patient has continued indicators of active disease (e.g., biomarkers in serum assay, biopsy, microbiologic culture, radiographic evidence) OR
B. BOTH of the following: 1. Patient has diagnosis other than invasive aspergillosis or invasive mucormycosis AND 2. There is support for continued use of the requested agent for the requested indication AND
Patient does NOT have any FDA labeled contraindications to the requested agent

6 months