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bosutinib — CareFirst (Caremark)

Myeloid/lymphoid neoplasms with eosinophilia and ABL1 rearrangement (chronic phase or blast phase)

Initial criteria

  • Diagnosis of myeloid and/or lymphoid neoplasm with eosinophilia confirmed by testing or analysis demonstrating ABL1 rearrangement

Reauthorization criteria

  • No evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

Initial 12 months; Reauthorization 12 months