Imbruvica — CareFirst (Caremark)
Chronic lymphocytic leukemia (CLL)
Initial criteria
- For CLL/SLL: Imbruvica used as a single agent, or in combination with rituximab with or without bendamustine, or in combination with obinutuzumab, or as first line therapy in combination with venetoclax
- For Histologic (Richter) transformation to diffuse large B-cell lymphoma: Imbruvica used in combination with nivolumab or pembrolizumab
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on Imbruvica
Approval duration
12 months