Ayvakit (avapritinib) — Highmark
Indolent Systemic Mastocytosis (ISM)
Initial criteria
- age ≥ 18 years
- diagnosis of one of the following: aggressive systemic mastocytosis (ICD-10: C96.21) OR systemic mastocytosis with an associated hematological neoplasm (ICD-10: D47.02) OR mast cell leukemia (ICD-10: C94.3) OR indolent systemic mastocytosis (ICD-10: D47.02)
- platelet count ≥ 50 x 10^9/L
Reauthorization criteria
- prescriber attests that the member is tolerating therapy
- therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months