Pomalyst (pomalidomide) — United Healthcare
Multiple Myeloma
Initial criteria
- Diagnosis of multiple myeloma
- AND
- One of the following:
- History of failure, contraindication, or intolerance to one of the following:
- Immunomodulatory agent [e.g., Revlimid (lenalidomide)]
- Proteasome inhibitor [e.g., Velcade (bortezomib)]
- Anti CD-38 therapy [e.g., Darzalex (daratumumab), Sarclisa (isatuximab)]
- OR
- Induction therapy for the management of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Pomalyst therapy
Approval duration
12 months