Purixan — CareFirst (Caremark)

Preferred products

• mercaptopurine

Initial criteria

• Member has a documented intolerable adverse event with the generic alternative mercaptopurine and the adverse event was not an expected adverse event attributed to the active ingredient as described in the prescribing information OR Member is unable to swallow the tablet formulation

Reauthorization criteria

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

Approval duration

12 months