vorasidenib — CareFirst (Caremark)
Grade 2 astrocytoma with a susceptible IDH1 or IDH2 mutation
Initial criteria
- Member age ≥ 12 years
- Medical record documentation of isocitrate dehydrogenase-1 (IDH1) or isocitrate dehydrogenase-2 (IDH2) mutation
- Requested medication will be used following surgery, including biopsy, sub-total resection, or gross total resection OR used as adjuvant treatment as a single agent and member has Karnofsky Performance Status (KPS) < 60 OR member has progressive or recurrent disease and medication will be used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity
- No evidence of disease progression while on current regimen
Approval duration
12 months