Intron A (interferon alfa-2b) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of ATLL when the requested medication is used in combination with zidovudine.

Reauthorization criteria

• Authorization of 12 months 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