etanercept — Medica

Initial criteria

• age > 6 years
• Patient has tried at least one systemic treatment for graft-versus-host disease
• Medication is prescribed by or in consultation with an oncologist, hematologist, or a physician affiliated with a transplant center

Reauthorization criteria

• Patient has been established on therapy for at least 1 month

Approval duration

1 month initial, 3 months reauth