Jakafi (ruxolitinib tablets) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has peripheral T-cell lymphoma OR one of the following: T-cell prolymphocytic leukemia, T-cell large granular lymphocytic leukemia, hepatosplenic T-cell lymphoma, or breast implant-associated anaplastic large cell lymphoma AND patient has tried at least one systemic regimen (e.g., methotrexate, corticosteroids, cyclosporine, Lemtrada, fludarabine, mitoxantrone, or cyclophosphamide)

Approval duration

1 year