resmetirom — Blue Cross Blue Shield of Texas
other FDA labeled indication or compendia-supported use
Initial criteria
- Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG)
- No FDA labeled contraindications to requested agent
- ONE of: (A) Patient has another FDA labeled indication for requested agent and route of administration OR (B) Patient has another indication supported in compendia for requested agent and route of administration OR (C) Prescriber submitted TWO articles from major peer-reviewed medical journals supporting proposed use as generally safe and effective
Approval duration
12 months