Farydak (panobinostat) — Highmark

Initial criteria

• Diagnosis of multiple myeloma (ICD-10 C90.0) AND
• Use in combination with bortezomib and dexamethasone AND
• Member has received at least two prior regimens including bortezomib and an immunomodulatory agent

Reauthorization criteria

• The prescriber attests that the member is tolerating therapy AND
• The member has experienced a therapeutic response defined as disease improvement OR delayed disease progression

Approval duration

12 months