Vidaza — CareFirst (Caremark)
Accelerated phase or blast phase myeloproliferative neoplasm
Initial criteria
- Authorization may be granted for the treatment of accelerated phase or blast phase myeloproliferative neoplasm.
Reauthorization criteria
- Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Approval duration
12 months