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OnuregCareFirst (Caremark)

Acute Myeloid Leukemia (AML)

Initial criteria

  • Member has non-core binding factor (non-CBF) AML
  • Requested medication will be used as a single agent
  • Member has achieved first complete remission (CR) or complete remission with incomplete blood count recovery (CRi) following intensive induction chemotherapy
  • Member is not able to complete intensive curative therapy

Reauthorization criteria

  • No evidence of unacceptable toxicity
  • No evidence of disease progression while on current regimen

Approval duration

12 months