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requested hepatitis C agent — Blue Cross Blue Shield of Texas

hepatitis C virus infection or another FDA labeled or compendia-supported indication

Initial criteria

  • Member resides in Ohio AND the plan is Fully Insured or HIM Shop (SG)
  • The patient has no FDA-labeled contraindications to the requested agent AND ONE of the following: (1) patient has another FDA labeled indication for requested agent and route of administration OR (2) patient has another indication supported in compendia (DrugDex level 1, 2A, 2B; AHFS-DI supportive) OR (3) prescriber has submitted two peer-reviewed journal articles supporting safe and effective use (randomized, double blind, placebo controlled trials; case studies not acceptable)

Approval duration

12 months