Calquence (acalabrutinib) — United Healthcare

Initial criteria

• Diagnosis of mantle cell lymphoma (MCL)
• AND one of the following:
• • Patient has not received prior therapy for MCL AND patient is ineligible for autologous hematopoietic stem cell transplantation (HSCT) AND used in combination with bendamustine and rituximab
• OR
• • Patient has received at least one prior therapy for MCL

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Calquence therapy

Approval duration

12 months