Cequa will be approved when BOTH of the following are met:

    1. ONE of the following:

A. The patient has an FDA labeled indication for the requested medication

OR

B. The patient has an indication that is supported in CMS approved compendia for the requested medication

 AND

    2. ONE of the following:

A. The requested quantity (dose) does NOT exceed the program quantity limit

OR

B. BOTH of the following:

                i. The requested quantity (dose) is greater than the program quantity limit

 AND

                ii. The prescriber has provided information in support of therapy with a higher dose for the requested indication

Length of Approval: 12 months