Gleevec — CareFirst (Caremark)
Dermatofibrosarcoma Protuberans (DFSP)
Initial criteria
- Diagnosis of GIST, desmoid tumor, PVNS/TGCT, DFSP, or recurrent chordoma
Reauthorization criteria
- Member is receiving clinical benefit and there is no evidence of unacceptable toxicity while on the current regimen
Approval duration
12 months