Nuedexta — Blue Cross Blue Shield of Texas

Off-label or compendia-supported indications (Ohio Fully Insured or HIM Shop members)

Initial criteria

Member resides in Ohio
Plan is Fully Insured or HIM Shop (SG)
Patient does not have any FDA-labeled contraindications to the requested agent
One of the following: (1) patient has another FDA labeled indication for the requested agent and route of administration; OR (2) patient has a compendia-supported indication for the requested agent and route of administration; OR (3) prescriber has submitted two peer-reviewed journal articles supporting the proposed use as safe and effective

12 months