Calquence (acalabrutinib tablets) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient meets ONE of the following (i or ii):
• i. Patient has tried at least one systemic regimen [examples include rituximab, dexamethasone, cytarabine, carboplatin, cisplatin, oxaliplatin, cyclophosphamide, doxorubicin, vincristine, prednisone, methotrexate, bendamustine, bortezomib, or lenalidomide] OR
• ii. According to the prescriber, patient is not a candidate for a chemotherapy regimen OR
• Calquence is used in combination with rituximab

Approval duration

1 year