Joenja — Blue Cross Blue Shield of Texas

Initial criteria

• Diagnosis of activated phosphoinositide 3-kinase (PI3K) delta syndrome (APDS)
• Variant in either PIK3CD or PIK3R1 [chart notes required]
• If the patient has an FDA labeled indication, then ONE of the following: (A) Patient’s age is within FDA labeling for the requested indication; OR (B) There is support for using the requested agent for the patient’s age for the requested indication
• Patient's weight is ≥ 45 kg
• Prescriber is a specialist in genetic disorders or immunology (or has consulted with such a specialist)
• Patient does NOT have any FDA labeled contraindications to the requested agent

Reauthorization criteria

• Patient previously approved for the requested agent through the plan’s Prior Authorization process
• Patient has had clinical benefit with the requested agent
• Prescriber is a specialist in genetic disorders or immunology (or has consulted with such a specialist)
• Patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

BCBSIL: 12 months; Others: 6 months initial / 12 months renewal