Sprycel — CareFirst (Caremark)

Initial criteria

• Diagnosis confirmed by cytogenetic and/or molecular testing for one of the following: (a) Ph+ ALL/LL (Ph chromosome or BCR::ABL gene positive); OR (b) Ph-like B-ALL/LL with ABL-class kinase fusion; OR (c) T-cell ALL/LL with ABL-class translocation and relapsed or refractory disease
• Any of the following: member has not received prior therapy with TKI (e.g., bosutinib, imatinib, nilotinib, ponatinib); OR member experienced toxicity or intolerance to prior TKI; OR member experienced resistance and BCR::ABL1 mutation testing negative for T315I/A, F317L/V/I/C, and V299L
• OR member has received HSCT for Ph+ ALL/LL and BCR::ABL1 mutation testing negative for T315I/A, F317L/V/I/C, and V299L

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on current regimen
• Any of: Ph+ ALL/LL confirmed by Ph chromosome or BCR::ABL gene; OR Ph-like B-ALL/LL with ABL-class kinase fusion confirmed; OR T-cell ALL/LL with ABL-class translocation confirmed; OR member has received HSCT for ALL/LL

Approval duration

12 months