Jaypirca (pirtobrutinib) — CareFirst (Caremark)
Relapsed or refractory mantle cell lymphoma (MCL)
Initial criteria
- Member has relapsed or refractory MCL
- Member has tried at least two lines of prior systemic therapy, including a BTK inhibitor
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months