Jadenu — CareFirst (Caremark)

Initial criteria

• Member meets any of the following:
• Pretreatment serum ferritin level is greater than or equal to 800 mcg/L.
• Pretreatment liver iron concentration (LIC) is at least 5 mg Fe/g dw.
• Pretreatment serum ferritin level is greater than 300 mcg/L to less than 800 mcg/L and member has clinical or laboratory measures indicative of iron overload (e.g., liver disease, renal disease).
• Dose of deferasirox tablet for suspension/Exjade will not exceed 20 mg/kg per day.
• Dose of deferasirox/Jadenu will not exceed 14 mg/kg per day.

Reauthorization criteria

• Member is experiencing benefit from therapy as evidenced by a decrease in serum ferritin levels as compared to pretreatment baseline.
• Serum ferritin level is not consistently below 300 mcg/L.

Approval duration

12 months