Onureg — CareFirst (Caremark)
Peripheral T-Cell Lymphoma (PTCL)
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