Tasigna — CareFirst (Caremark)

Initial criteria

• Diagnosis of CML confirmed by detection of the Ph chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• Member has not received prior therapy with a TKI (e.g., asciminib, bosutinib, dasatinib, imatinib, ponatinib) OR member experienced toxicity or intolerance to prior TKI therapy OR member experienced resistance to prior TKI therapy and BCR::ABL1 mutational testing is negative for T315I, Y253H, E255K/V, F359V/C/I OR member has received HSCT for CML and BCR::ABL1 mutational testing is negative for T315I, Y253H, E255K/V, F359V/C/I

Reauthorization criteria

• Diagnosis of CML confirmed by detection of Ph chromosome or BCR::ABL gene by cytogenetic and/or molecular testing
• For members receiving treatment for 6 months or greater: BCR::ABL1 ≤ 10% and no evidence of disease progression or unacceptable toxicity OR member has received HSCT and no evidence of unacceptable toxicity or disease progression
• For members completing less than 6 months of therapy: no evidence of unacceptable toxicity or disease progression

Approval duration

Initial 7 months; continuation 7 or 12 months per criteria