nedosiran sodium — Blue Cross Blue Shield of Texas

off-label use under NM Fully Insured/HIM or OH Fully Insured/HIM members

Initial criteria

For BCBS NM Fully Insured or NM HIM member: (A) No FDA labeled contraindications AND (B) Requested indication is a rare disease AND (C) ONE of: has another FDA labeled indication OR has another compendia-supported indication for route
For Ohio Fully Insured or HIM Shop member: (A) Member resides in Ohio AND (B) Plan is Fully Insured or HIM Shop AND (C) No FDA labeled contraindications AND (D) ONE of: another FDA labeled indication OR compendia-supported indication OR prescriber has submitted two peer-reviewed journal articles supporting proposed use

12 months