Vidaza — CareFirst (Caremark)
Blastic plasmacytoid dendritic cell neoplasm (BPDCN)
Initial criteria
- Authorization may be granted for the treatment of BPDCN when used in combination with venetoclax in either of the following settings: (1) Treatment of relapsed or refractory disease, OR (2) Treatment of systemic disease with palliative intent.
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