Sprycel — CareFirst (Caremark)

Initial criteria

• Diagnosis of CML confirmed by detection of the Philadelphia chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• Member has not received prior therapy with a tyrosine kinase inhibitor (e.g., asciminib, bosutinib, imatinib, nilotinib, ponatinib) OR experienced toxicity or intolerance to prior TKI therapy OR experienced resistance to prior TKI therapy and results of BCR::ABL1 mutational testing are negative for T315I/A, F317L/V/I/C, and V299L OR member has received HSCT for CML and testing is negative for T315I/A, F317L/V/I/C, and V299L

Reauthorization criteria

• Diagnosis of CML confirmed by detection of Philadelphia chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• BCR::ABL1 is ≤ 10% and no evidence of disease progression or unacceptable toxicity while on current regimen for ≥ 6 months OR member has received HSCT and no evidence of unacceptable toxicity or disease progression while on current regimen

Approval duration

Initial: 7 months; Reauthorization: up to 12 months or 7 months if <6 months of therapy completed