Xpovio (selinexor) — Highmark
Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Initial criteria
- age ≥ 18 years
- diagnosis of relapsed or refractory DLBCL (ICD-10: C83.3)
- has experienced therapeutic failure, contraindication, or intolerance to at least two lines of systemic therapy
Reauthorization criteria
- prescriber attests member is tolerating therapy AND has experienced therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months