Skip to content
The Policy VaultThe Policy Vault

Valchlor (mechlorethamine topical gel) — Cigna

Cutaneous lymphomas (including mycosis fungoides/Sezary syndrome, primary cutaneous B-cell lymphoma, primary cutaneous CD30+ T-cell lymphoproliferative disorders)

Initial criteria

  • Patient has cutaneous lymphomas (including mycosis fungoides/Sezary syndrome, primary cutaneous B-cell lymphoma, or primary cutaneous CD30+ T-cell lymphoproliferative disorders)
  • Patient age ≥ 18 years

Approval duration

1 year