Vidaza — CareFirst (Caremark)
Myelodysplastic syndrome (MDS)/Myeloproliferative neoplasms (MPN) overlap neoplasms
Initial criteria
- Authorization may be granted for the treatment of MDS/MPN overlap neoplasms including chronic myelomonocytic leukemia (CMML), juvenile myelomonocytic leukemia (JMML), BCR-ABL negative atypical chronic myeloid leukemia (aCML), MDS/MPN with neutrophilia, unclassifiable MDS/MPN, MDS/MPN not otherwise specified (NOS), MDS/MPN with ring sideroblasts and thrombocytosis, or MDS/MPN with SF3B1 mutation.
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