Copiktra (duvelisib) — CareFirst (Caremark)
Hepatosplenic T‑Cell lymphoma
Initial criteria
- Requested drug is used for refractory disease after 2 first‑line therapy regimens
- Requested drug is used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity
- No evidence of disease progression while on current regimen
Approval duration
12 months