selinexor — CareFirst (Caremark)

Initial criteria

• Requested medication will be used in combination with dexamethasone for relapsed or refractory disease AND member has received at least four prior therapy regimens AND member is refractory to at least two proteasome inhibitors AND member is refractory to at least two immunomodulatory agents AND member is refractory to an anti-CD38 monoclonal antibody
• OR requested medication will be used for relapsed or progressive disease in combination with any of the following: bortezomib and dexamethasone; daratumumab and dexamethasone; carfilzomib and dexamethasone; pomalidomide and dexamethasone after member has received at least two prior therapies including an immunomodulatory agent and a proteasome inhibitor

Reauthorization criteria

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

Approval duration

12 months