Copiktra (duvelisib) — CareFirst (Caremark)
Peripheral T‑Cell lymphoma (PTCL)
Initial criteria
- Requested drug is used as palliative or subsequent therapy for relapsed or refractory disease
- 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