Zolinza (vorinostat) — Highmark
Cutaneous manifestations of cutaneous T-cell lymphoma (CTCL)
Initial criteria
- age ≥ 18 years
- treated for cutaneous manifestations of CTCL (ICD-10: C84.A)
- progressive, persistent, or recurrent disease on or following two systemic therapies (e.g., bexarotene (Targretin), interferon-α, extracorporeal photochemotherapy, PUVA, single agent or combination chemotherapies)
Reauthorization criteria
- prescriber attests that the member is tolerating therapy
- member has experienced a therapeutic response defined as: disease improvement OR delayed disease progression
Approval duration
12 months