Copiktra (duvelisib) — United Healthcare
Hepatosplenic T-cell lymphoma
Initial criteria
- Diagnosis of hepatosplenic T-cell lymphoma
- Disease is relapsed or refractory
- History of failure, contraindication, or intolerance to at least two prior systemic therapies
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Copiktra therapy
Approval duration
12 months