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imatinib mesylate — CareFirst (Caremark)

Pigmented Villonodular Synovitis/Tenosynovial Giant Cell Tumor (PVNS/TGCT)

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