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Iclusig (ponatinib) — CareFirst (Caremark)

Myeloid/Lymphoid Neoplasms with Eosinophilia and FGFR1 or ABL1 rearrangement

Initial criteria

  • Diagnosis of myeloid and/or lymphoid neoplasms with eosinophilia confirmed by testing showing FGFR1 or ABL1 rearrangement in chronic phase or blast phase

Reauthorization criteria

  • No evidence of unacceptable toxicity or disease progression while on current regimen

Approval duration

12 months