Copiktra (duvelisib) — United Healthcare
Breast implant-associated anaplastic large cell lymphoma (ALCL)
Initial criteria
- Diagnosis of breast implant-associated anaplastic large cell lymphoma
- Disease is relapsed or refractory
- Used as second-line and subsequent therapy
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Copiktra therapy
Approval duration
12 months