Calquence (acalabrutinib) — United Healthcare

Initial criteria

• Diagnosis of one of the following: nodal marginal zone lymphoma, extranodal marginal zone lymphoma (EMZL) of the stomach, splenic marginal zone lymphoma, extranodal marginal zone lymphoma of nongastric sites (noncutaneous)
• AND disease is recurrent, relapsed, refractory, or progressive

Reauthorization criteria

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

Approval duration

12 months