Venclexta (venetoclax) — Highmark

Initial criteria

• age ≥ 18 years
• newly diagnosed AML (ICD-10 C92.0)
• Venclexta used in combination with azacitidine OR decitabine OR low-dose cytarabine
• member has at least one comorbidity that precludes use of intensive induction chemotherapy defined as one of the following: age ≥ 75 years OR severe cardiac or pulmonary comorbidity OR reduced renal function OR hepatic impairment OR prescriber attests that member is not a candidate for intensive induction therapy

Reauthorization criteria

• prescriber attests that the member is tolerating therapy AND has experienced a therapeutic response defined as either disease improvement OR delayed disease progression

Approval duration

12 months