Mavenclad (cladribine) — Blue Cross Blue Shield of Texas

Initial criteria

• For BCBS MT Fully Insured or MT HIM members: The patient is under age < 18 years AND has no FDA labeled contraindications AND has an indication supported in TWO articles from major peer-reviewed professional medical journals (e.g., JAMA, NEJM, Lancet) demonstrating general safety and efficacy AND there is support for the patient’s age bracket (infancy, childhood, adolescence) in TWO such journal articles.
• For Ohio Fully Insured or HIM Shop (SG) members: The member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG) AND the patient does NOT have any FDA labeled contraindications AND further region-specific criteria apply (not continued in the extract).