Daurismo (glasdegib) — Highmark
newly diagnosed acute myeloid leukemia (AML)
Initial criteria
- age ≥ 18 years
- Diagnosis of newly-diagnosed acute myeloid leukemia (ICD-10: C92)
- Daurismo is used in combination with low-dose cytarabine
- Member has at least one comorbidity that precludes intensive induction chemotherapy, defined as one of the following: age ≥ 75 years, severe cardiac or pulmonary comorbidity, reduced renal function, hepatic impairment, or prescriber attests that the member is not a candidate for intensive induction therapy
Reauthorization criteria
- Prescriber attests that the member is tolerating therapy and has experienced a therapeutic response defined as disease improvement or delayed disease progression
Approval duration
12 months