requested agent (Ohio provision) — Blue Cross Blue Shield of Texas
any other FDA labeled or compendia supported indication or supported by two peer-reviewed journal articles
Initial criteria
- Member resides in Ohio
- Plan is Fully Insured or HIM Shop (SG)
- No FDA labeled contraindications
- One of: other FDA labeled indication and route; other indication supported in compendia; two supporting peer-reviewed journal articles
Approval duration
12 months