Procysbi (cysteamine bitartrate) — Blue Cross Blue Shield of Texas

Initial criteria

• The member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
• AND patient has no FDA labeled contraindications to the requested agent
• AND ONE of the following: (1) Patient has another FDA labeled indication for the requested agent and route of administration OR (2) Patient has another indication supported in compendia for the requested agent and route of administration OR (3) Prescriber has submitted TWO peer-reviewed journal articles supporting the proposed use as generally safe and effective; case studies not acceptable

Approval duration

12 months