Releuko — CareFirst (Caremark)
Chronic Myeloid Leukemia (CML) for treatment of persistent neutropenia due to tyrosine kinase inhibitor therapy
Initial criteria
- Authorization of 6 months may be granted for members with listed indications
- Members must meet relevant clinical criteria associated with the specified indication
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all initial authorization criteria
Approval duration
6 months