Inqovi (decitabine and cedazuridine) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of MDS/MPN overlap neoplasms including chronic myelomonocytic leukemia (CMML), BCR-ABL negative atypical chronic myeloid leukemia (aCML), MDS/MPN with neutrophilia, unclassifiable MDS/MPN, MDS/MPN not otherwise specified (NOS), MDS/MPN with ring sideroblasts and thrombocytosis, or MDS/MPN with SF3B1 mutation.

Reauthorization criteria

• Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months