Gleevec — CareFirst (Caremark)
Aggressive Systemic Mastocytosis (ASM)
Initial criteria
- Treatment used as a single agent AND one of the following:
- D816V c-KIT mutation is negative OR
- D816V c-KIT mutation status is unknown OR
- Well-differentiated systemic mastocytosis (WDSM) OR
- Eosinophilia present with FIP1L1::PDGFRA fusion gene
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months