Xospata (gilteritinib) — Highmark
relapsed or refractory acute myeloid leukemia (AML)
Initial criteria
- age ≥ 18 years
- diagnosis of relapsed or refractory AML
- FLT3 mutation-positive as detected by an FDA-approved test
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