Pomalyst (pomalidomide) — United Healthcare

Initial criteria

• Diagnosis of primary CNS lymphoma
• AND
• One of the following:
• Used as second-line or a subsequent therapy
• Use as induction therapy if patient is unsuitable for or intolerant to high-dose methotrexate

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Pomalyst therapy

Approval duration

12 months