Iclusig (ponatinib tablets) — Cigna
Myeloid/Lymphoid Neoplasms with Eosinophilia
Initial criteria
- Approve for 1 year if the patient meets BOTH of the following (A and B):
- A) Patient is age ≥ 18 years; AND
- B) Patient meets ONE of the following (i or ii):
- i. The tumor has an ABL1 rearrangement; OR
- ii. The tumor has an FGFR1 rearrangement.
Approval duration
1 year