Joenja (leniolisib) — CareFirst (Caremark)
Activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome (APDS)
Initial criteria
- Member’s diagnosis was confirmed by genetic testing demonstrating variant in either the PIK3CD or PIK3R1 gene
- Member has clinical manifestations of disease (e.g., history of repeated oto-sino-pulmonary infections, lymphoproliferation, autoimmunity [e.g., cytopenia], enteropathy, organ dysfunction [e.g., lung, liver])
- Member is age ≥ 12 years and weight ≥ 45 kg
- Medication is prescribed by or in consultation with an immunologist or a physician who specializes in the treatment of APDS
Reauthorization criteria
- Member is currently receiving the requested medication
- Member is experiencing benefit from therapy as evidenced by disease stability or disease improvement
Approval duration
Initial: 6 months; Reauthorization: 12 months