Tazverik (tazemetostat) — Highmark
Relapsed or refractory follicular lymphoma (FL) (EZH2 mutation positive after ≥2 prior systemic therapies OR no satisfactory alternative treatment options)
Initial criteria
- age ≥ 18 years
- diagnosis of relapsed or refractory follicular lymphoma (ICD-10: C82)
- EITHER tumors positive for an EZH2 mutation as detected by an FDA-approved test AND member has received at least two prior systemic therapies OR prescriber attests member has no satisfactory alternative treatment options
Reauthorization criteria
- prescriber attests member is tolerating therapy
- prescriber attests member has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months