pacritinib — CareFirst (Caremark)

Initial criteria

• Member has a platelet count of <50 × 10^9/L AND any of the following: symptomatic low-risk MF OR intermediate or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) MF
• OR member has high-risk MF and symptomatic disease (e.g., splenomegaly and other disease-related symptoms)
• OR member has MF-associated anemia with symptomatic splenomegaly and/or constitutional symptoms (e.g., fatigue, night sweats, fever, weight loss)
• OR member has symptomatic accelerated phase or blast phase myeloproliferative neoplasms AND the requested agent will be used as a single agent or in combination with azacitidine or decitabine

Reauthorization criteria

• No evidence of unacceptable toxicity
• Improvement in symptoms while on the current regimen

Approval duration

12 months