Copiktra (duvelisib) — Highmark
Relapsed or refractory small lymphocytic lymphoma (SLL)
Initial criteria
- age ≥ 18 years
- Diagnosis of chronic lymphocytic leukemia (ICD-10: C91.1) OR small lymphocytic lymphoma (ICD-10: C83)
- Disease is relapsed or refractory
- No longer responding to or intolerant to at least two prior therapies (e.g., ibrutinib, alemtuzumab ± rituximab, HDMP + rituximab, obinutuzumab, venetoclax + rituximab)
Reauthorization criteria
- Prescriber attests the member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months