Brukinsa (zanubrutinib) — CareFirst (Caremark)

Mantle cell lymphoma (MCL)

Initial criteria

Member is an adult (age ≥ 18 years).
Brukinsa will be used as a single agent when the member has received at least one prior therapy OR
Brukinsa will be used as a component of TRIANGLE regimen for members with TP53 mutations for induction therapy (TRIANGLE regimen = alternating RCHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] + Brukinsa/RDHAP [rituximab, dexamethasone, and cytarabine] + platinum [carboplatin, cisplatin, or oxaliplatin] regimen) OR
Brukinsa will be used in combination with rituximab for pre-induction therapy or maintenance therapy OR
Brukinsa will be used as induction therapy for TP53 mutated disease in combination with Venclexta (venetoclax) and Gazyva (obinutuzumab).

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

12 months