Rydapt (midostaurin) — Highmark

Initial criteria

• age ≥ 18 years
• EITHER newly diagnosed AML AND all of the following:
• - Rydapt used in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation chemotherapy regimens
• - FLT3 mutation-positive as detected by an FDA-approved test
• OR diagnosis of one of the following: ASM, SM-AHN, or MCL

Reauthorization criteria

• Prescriber attests member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression

Approval duration

12 months