Sprycel — Medica
patient meets standard Oncology – Dasatinib Prior Authorization Policy criteria (i.e., approved dasatinib indications such as Ph+ ALL or Ph+ CML)
Preferred products
- generic dasatinib tablets
Initial criteria
- Patient meets the standard Oncology – Dasatinib Prior Authorization Policy criteria; AND
- Patient has tried generic dasatinib tablets [documentation required]; AND
- Patient cannot continue to use the Preferred medication due to a formulation difference in inactive ingredient(s) which, per the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
1 year