Imkeldi — CareFirst (Caremark)
Gastrointestinal Stromal Tumor (GIST)
Preferred products
- Gleevec
- imatinib mesylate
Initial criteria
- Diagnosis of GIST, desmoid tumors, PVNS/TGCT, DFSP, or recurrent chordoma
Reauthorization criteria
- GIST: receiving clinical benefit and no unacceptable toxicity while on current regimen
- Other indications: no evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months