all other targeted medications — Highmark
FDA-approved indication(s)
Initial criteria
- Coverage will be approved when the medication is used for an FDA-approved indication AND the member meets one of the following:
- For an Rx with OTC Equivalent medication, the member must try and fail the similar chemical entity product available over the counter.
- For a High Cost Low Value medication, the member must try and fail ALL therapeutic alternatives listed in the middle column of the table for the corresponding targeted medication.
- For a New to Market medication, the member must try and fail ALL therapeutic alternatives available.
Approval duration
12 months