Xpovio (selinexor) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of relapsed or refractory MM (ICD-10: C90)
• use in combination with dexamethasone
• has experienced therapeutic failure, contraindication, or intolerance to ALL of the following: two proteasome inhibitors (e.g., bortezomib, carfilzomib), two immunomodulatory agents (e.g., lenalidomide, pomalidomide), one anti-CD38 monoclonal antibody (e.g., daratumumab)

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