Zydelig (idelalisib) — Highmark
relapsed chronic lymphocytic leukemia (CLL)
Initial criteria
- age ≥ 18 years
- diagnosis of relapsed CLL
- idelalisib will be used in combination with rituximab
- use of rituximab alone would be appropriate due to other comorbidities
Reauthorization criteria
- prescriber attests that the member is tolerating therapy
- member has experienced therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months