Jaypirca (pirtobrutinib) — United Healthcare
B-cell lymphomas (extranodal marginal zone lymphoma of nongastric sites (noncutaneous), extranodal marginal zone lymphoma of the stomach, mantle cell lymphoma (MCL), nodal marginal zone lymphoma, splenic marginal zone lymphoma)
Preferred products
- Imbruvica (ibrutinib)
- Calquence (acalabrutinib)
- Brukinsa (zanubrutinib)
Initial criteria
- Diagnosis of one of the following: extranodal marginal zone lymphoma of nongastric sites (noncutaneous) OR extranodal marginal zone lymphoma of the stomach OR mantle cell lymphoma (MCL) OR nodal marginal zone lymphoma OR splenic marginal zone lymphoma
- Disease is relapsed, refractory, or progressive
- Patient has received at least two prior systemic therapies [e.g., chemotherapy], one of which is a Bruton Tyrosine Kinase (BTK) inhibitor therapy [e.g., Imbruvica (ibrutinib), Calquence (acalabrutinib), Brukinsa (zanubrutinib)]
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Jaypirca therapy
Approval duration
12 months