olutasidenib — CareFirst (Caremark)
Relapsed or refractory acute myeloid leukemia (AML) with a susceptible IDH1 mutation
Initial criteria
- Member is an adult
- Diagnosis of relapsed or refractory acute myeloid leukemia (AML)
- Disease has a susceptible isocitrate dehydrogenase-1 (IDH1) mutation as detected by an FDA-approved test
- Rezlidhia will be used as a single agent
Reauthorization criteria
- Member is requesting reauthorization for an indication listed in the coverage criteria section
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months