Oxervate (cenegermin-bkbj) — Blue Cross Blue Shield of Texas
other approved/off-label uses per Ohio plan criteria
Initial criteria
- Member resides in Ohio
- Plan is Fully Insured or HIM Shop (SG)
- No FDA labeled contraindications
- ONE of the following:
- A. Patient has another FDA labeled indication for requested agent and route OR
- B. Patient has another indication supported in recognized compendia (DrugDex level 1/2A/2B, AHFS-DI supportive narrative, or NCCN 1/2A, Clinical Pharmacology, LexiDrugs level A) OR
- C. Prescriber has submitted ≥ 2 peer-reviewed journal articles supporting proposed use as generally safe and effective (randomized, double blind, placebo controlled acceptable)
Approval duration
12 months