Exjade (deferasirox) — United Healthcare
Chronic iron overload in non-transfusion dependent thalassemia (NTDT) syndromes
Initial criteria
- Diagnosis of chronic iron overload in non-transfusion dependent thalassemia (NTDT) syndrome
- Patient has liver iron (Fe) concentration (LIC) levels consistently ≥ 5 mg Fe per gram of dry weight prior to initiation of treatment with Exjade or Jadenu
- Patient has serum ferritin levels consistently > 300 mcg/L prior to initiation of treatment with Exjade or Jadenu
Reauthorization criteria
- Documentation of positive clinical response to Exjade or Jadenu therapy
Approval duration
12 months