Zepbound — Blue Cross Blue Shield of Texas

rare disease or compendia-supported use (BCBS NM Fully Insured or NM HIM or Ohio Fully Insured/HIM Shop members)

Initial criteria

Patient does NOT have FDA labeled contraindications to requested agent
Requested indication is a rare disease OR another FDA labeled indication OR indication supported in compendia OR prescriber has submitted two articles from major peer-reviewed medical journals supporting proposed use as safe and effective
Non-oncology compendia allowed: DrugDex level 1, 2A, 2B or AHFS-DI supportive narrative
Oncology compendia allowed: NCCN 1 or 2A, AHFS-DI supportive narrative, DrugDex level 1, 2A, 2B, Clinical Pharmacology supportive narrative, LexiDrugs evidence level A, or peer-reviewed medical literature

12 months