Xpovio — CareFirst (Caremark)

Initial criteria

• Requested medication will be used as a single agent for the treatment of B-cell lymphoma AND member has partially responsive, non-responsive, progressive, relapsed, or refractory disease AND member has received at least 2 prior lines of systemic therapy (includes transplant or CAR T-cell therapy) AND member has one of the following B-cell lymphoma subtypes: HIV-related diffuse large B-cell lymphoma (DLBCL); HIV-related primary effusion lymphoma; HIV-related HHV8-positive DLBCL; DLBCL including transformed DLBCL arising from follicular lymphoma; high-grade B-cell lymphoma; monomorphic post-transplant lymphoproliferative disorder (B-cell type)

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months