Hetlioz — Blue Cross Blue Shield of Texas

any indication meeting Ohio fully insured or HIM Shop (SG) plan criteria

Initial criteria

1. Member resides in Ohio.
2. Plan is Fully Insured or HIM Shop (SG).
3. BOTH of the following:
A. Patient does NOT have any FDA labeled contraindications to the requested agent AND
B. ONE of the following: (1) another FDA labeled indication for agent and route OR (2) another compendia-supported indication for agent and route OR (3) prescriber submitted two peer-reviewed journal articles (e.g., JAMA, NEJM, Lancet) supporting proposed use as generally safe and effective with appropriate study design; case studies not acceptable.

12 months