ivosidenib — CareFirst (Caremark)
Central Nervous System (CNS) Cancers
Initial criteria
- Treatment as a single agent for IDH1 mutant astrocytoma (WHO grade 2) when member has recurrent or progressive disease OR medication will be used as adjuvant treatment
- Treatment as a single agent for IDH1 mutant oligodendroglioma (WHO grade 2 or 3) when member has recurrent or progressive disease OR (for WHO grade 2) medication will be used as adjuvant treatment
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months