Zelboraf (vemurafenib tablets) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has tried at least one other systemic therapy for hairy cell leukemia (e.g., cladribine, Nipent (pentostatin injection), rituximab, Intron A (interferon alpha-2b injection)) OR Patient is unable to tolerate purine analogs (active infection, frail patients) AND Zelboraf is used in combination with rituximab or Gazyva (obinutuzumab intravenous infusion)

Approval duration

1 year