Ninlaro (ixazomib) — Highmark
multiple myeloma
Initial criteria
- Diagnosis of multiple myeloma (ICD10: C90.00, C90.01, C90.02)
- Member has received at least one prior therapy for multiple myeloma
- Ninlaro is used in combination with lenalidomide and dexamethasone
Reauthorization criteria
- Prescriber attests member is tolerating therapy
- Member has experienced a therapeutic response defined as either disease improvement OR delayed disease progression
Approval duration
12 months