Rydapt (midostaurin) — Highmark
systemic mastocytosis with associated hematological neoplasm (SM-AHN)
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