Pomalyst (pomalidomide) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of relapsed or refractory systemic light chain amyloidosis in combination with dexamethasone.

Reauthorization criteria

• Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months