tazemetostat — CareFirst (Caremark)
relapsed or refractory follicular lymphoma (with or without EZH2 mutation)
Initial criteria
- relapsed or refractory follicular lymphoma
- member age ≥ 18 years
- member has received at least 2 prior therapies OR member does not have any satisfactory alternative treatment options
Reauthorization criteria
- no evidence of unacceptable toxicity
- no evidence of disease progression while on the current regimen
Approval duration
12 months