Rydapt (midostaurin) — United Healthcare

Initial criteria

• Diagnosis of one of the following: aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematologic neoplasm (SM-AHN), or mast cell leukemia (MCL)

Reauthorization criteria

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

Approval duration

12 months