Inqovi (decitabine/cedazuridine) — Highmark

Initial criteria

• age ≥ 18 years
• Diagnosis of one of the following:
• MDS when one of the following criteria is met:
• Member has been diagnosed with one of the following French American-British MDS subtypes: refractory anemia OR refractory anemia with ringed sideroblasts OR refractory anemia with excess blasts
• OR Member has a diagnosis of one of the following International Prognostic Scoring System (IPSS) groups: Intermediate-1 OR Intermediate-2 OR High-risk
• OR Chronic myelomonocytic leukemia (CMML)

Reauthorization criteria

• Prescriber attests that the member is tolerating therapy and has experienced a therapeutic response defined as one of the following:
• Disease improvement
• Delayed disease progression

Approval duration

12 months