Erelzi — Medical Mutual

Initial criteria

• Patient age ≥ 6 years
• Tried one conventional systemic treatment for GVHD (corticosteroids, antithymocyte globulin, cyclosporine, tacrolimus, mycophenolate)
• Medication prescribed by or in consultation with oncologist, hematologist, or transplant physician

Reauthorization criteria

• Patient established on therapy ≥ 1 month
• Beneficial clinical response (e.g., normalization of labs, resolution of fever/rash) OR symptom improvement (skin, mucosal, ocular, GI)

Approval duration

initial 1 month, reauth 3 months