Inrebic (fedratinib) — CareFirst (Caremark)

Myeloid and/or lymphoid neoplasms with eosinophilia and JAK2 rearrangement in the chronic phase or blast phase

Initial criteria

For myelofibrosis/myeloproliferative neoplasms: Member has intermediate-2 or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis, or splenomegaly and other disease-related symptoms of MF-associated anemia, or accelerated phase or blast phase myeloproliferative neoplasms.
For myeloid/lymphoid neoplasms: Member has myeloid and/or lymphoid neoplasms with eosinophilia and JAK2 rearrangement in the chronic phase or blast phase.
Submission of testing or analysis confirming JAK2 rearrangement if applicable.

For myelofibrosis/myeloproliferative neoplasms: No evidence of unacceptable toxicity and improvement in symptoms.
For myeloid/lymphoid neoplasms: No evidence of unacceptable toxicity or disease progression while on current regimen.

12 months