Imkeldi — CareFirst (Caremark)

Preferred products

• Gleevec
• imatinib mesylate

Initial criteria

• Diagnosis of CML confirmed by detection of the Ph chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• Member did not fail (other than due to intolerance) prior therapy with a tyrosine kinase inhibitor (asciminib, dasatinib, nilotinib, bosutinib, ponatinib)

Reauthorization criteria

• Diagnosis of CML confirmed by detection of Ph chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• If therapy ≥ 6 months: BCR::ABL1 less than or equal to 10% and no evidence of disease progression or unacceptable toxicity while on current regimen, or member has received HSCT and no disease progression or unacceptable toxicity
• If therapy < 6 months: member has completed less than 6 months of therapy with the requested medication

Approval duration

Initial: 7 months; Reauthorization: up to 12 months (7 months if <6 months on therapy)