Imkeldi — United Healthcare
Patients unable to ingest solid dosage forms requiring imatinib
Initial criteria
- ONE of the following: (a) Patient is less than 19 years of age OR (b) BOTH of the following: (1) Patient is unable to ingest a solid dosage form (e.g. an oral tablet or capsule) due to age OR oral/motor difficulties OR dysphagia OR utilizes feeding tube for medication administration AND (2) Patient is unable to achieve desired dose by dissolving imatinib 100 mg or 400 mg tablets in water or apple juice
Approval duration
12 months