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Calquence (acalabrutinib) — CareFirst (Caremark)

Gastric MALT lymphoma (extranodal marginal zone lymphoma of the stomach)

Initial criteria

  • Authorization may be granted for treatment when used as subsequent therapy.

Reauthorization criteria

  • Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months