Imkeldi — CareFirst (Caremark)
Aggressive Systemic Mastocytosis (ASM)
Preferred products
- Gleevec
- imatinib mesylate
Initial criteria
- Used as a single agent
- Any of the following: D816V c-KIT mutation negative, D816V c-KIT mutation status unknown, well-differentiated systemic mastocytosis, or eosinophilia present with FIP1L1::PDGFRA fusion gene
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months