Pemazyre (pemigatinib) — United Healthcare
Myeloid/lymphoid/mixed lineage neoplasms with eosinophilia
Initial criteria
- Diagnosis of myeloid/lymphoid/mixed lineage neoplasms with eosinophilia
- AND Presence of an FGFR1 rearrangement
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Pemazyre therapy
Approval duration
12 months