Rydapt (midostaurin) — CareFirst (Caremark)
Acute Myeloid Leukemia (AML)
Initial criteria
- Member has FLT3 mutation-positive AML as detected by an FDA-approved test
- Rydapt is used in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation chemotherapy
- Rydapt is not used as a single-agent for induction therapy
Reauthorization criteria
- No evidence of unacceptable toxicity
Approval duration
12 months