crinecerfont — Blue Cross Blue Shield of Texas

other FDA labeled or compendia-supported indications (rare disease exception policies for NM or OH members)

Initial criteria

For BCBS NM Fully Insured or NM HIM member: ALL of the following must be met:
The patient does NOT have any FDA-labeled contraindications to the requested agent
The requested indication is a rare disease
ONE of the following: (1) The patient has another FDA-labeled indication for the requested agent and route of administration OR (2) The patient has another indication that is supported in compendia for the requested agent and route of administration
OR for Ohio Fully Insured or HIM Shop (SG) member: ALL of the following must be met:
The member resides in Ohio
The plan is Fully Insured or HIM Shop (SG)
The patient does NOT have any FDA-labeled contraindications to the requested agent
ONE of the following: (1) The patient has another FDA-labeled indication for the requested agent and route of administration OR (2) The patient has another indication that is supported in compendia for the requested agent and route of administration OR (3) The prescriber has submitted TWO articles from major peer-reviewed professional medical journals supporting the proposed use(s) as generally safe and effective

12 months