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The Policy VaultThe Policy Vault

ActimmuneCareFirst (Caremark)

Mycosis Fungoides/Sezary Syndrome

Initial criteria

  • Member is prescribed Actimmune for treatment of mycosis fungoides or Sezary syndrome
  • Medication must be prescribed by or in consultation with a hematologist or oncologist

Reauthorization criteria

  • Member is experiencing benefit from therapy as evidenced by disease stability or disease improvement
  • Member continues to meet the indication listed in the coverage criteria

Approval duration

12 months