Onureg — CareFirst (Caremark)
nodal peripheral T-cell lymphoma with TFH phenotype (PTCL, TFH)
Initial criteria
- Requested medication will be used as subsequent therapy for relapsed or refractory disease
- Requested medication will be used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity
- No evidence of disease progression while on current regimen
Approval duration
12 months