Jaypirca (pirtobrutinib) — CareFirst (Caremark)
Histologic (Richter’s) transformation to diffuse large B-cell lymphoma
Initial criteria
- Requested as a single agent
- Diagnosis of histologic (Richter’s) transformation to diffuse large B-cell lymphoma
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months