ibrutinib — CareFirst (Caremark)
Central nervous system cancers (including primary CNS lymphoma and brain metastases in lymphoma)
Initial criteria
- Imbruvica used for relapsed or refractory disease as either a single agent or in combination with high-dose methotrexate and rituximab for primary CNS lymphoma
- OR Imbruvica used for induction therapy as a single agent for primary CNS lymphoma
- OR Imbruvica used as a single agent for brain metastases in lymphoma
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on Imbruvica
Approval duration
12 months