ibrutinib — CareFirst (Caremark)
Waldenström’s macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL)
Initial criteria
- Imbruvica used as a single agent or in combination with rituximab
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on Imbruvica
Approval duration
12 months