Daurismo (glasdegib) — United Healthcare

Initial criteria

• Diagnosis of newly-diagnosed acute myeloid leukemia (AML) OR relapsed/refractory disease with ALL of the following: given as a component of repeating the initial successful induction regimen, late relapse (≥12 months since induction regimen), initial therapy was not administered continuously, and initial therapy was not stopped due to development of clinical resistance
• Daurismo therapy to be given in combination with low-dose cytarabine
• Patient is ≥ 75 years old OR patient has significant comorbidities that preclude the use of intensive induction chemotherapy (e.g., severe cardiac disease, ECOG performance status ≥ 2, baseline creatinine >1.3 mg/dL)

Reauthorization criteria

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

Approval duration

12 months