Iwilfin (eflornithine) — CareFirst (Caremark)
Reduce the risk of relapse in adult and pediatric patients with high-risk neuroblastoma (HRNB) who have demonstrated at least a partial response to prior multiagent, multimodality therapy including anti-GD2 immunotherapy
Initial criteria
- Member has high-risk neuroblastoma (HRNB)
- Member has demonstrated at least a partial response to prior multiagent, multimodality therapy including anti-GD2 immunotherapy (e.g., dinutuximab [Unituxin], naxitamab-gqgk [Danyelza])
Reauthorization criteria
- Request is for continued treatment of the indication listed in the coverage criteria section
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months (up to 24 months total therapy)