Oxervate (cenegermin-bkbj) — Blue Cross Blue Shield of Texas
pediatric and other plan-specific indications
Initial criteria
- Request is for a BCBS MT Fully Insured or MT HIM member
- Patient age < 18 years
- No FDA labeled contraindications to requested agent
- Indication supported in ≥ 2 major peer-reviewed medical journal articles as generally safe and effective (e.g., JAMA, NEJM, Lancet)
- Age bracket supported in ≥ 2 major peer-reviewed journal articles as safe and effective (infancy, childhood, or adolescence as defined)
Approval duration
12 months