Scemblix (asciminib) — United Healthcare
Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML)
Initial criteria
- Diagnosis of chronic myeloid leukemia (CML)
- AND Disease is Philadelphia chromosome (Ph+) or BCR:ABL1-positive
- AND One of the following:
- - Used in newly diagnosed chronic phase CML (CP-CML)
- - OR Used in previously treated chronic phase CML (CP-CML)
- - OR Used in chronic phase CML (CP-CML) positive for a T315I mutation
- - OR Used in accelerated phase CML as primary treatment as a single agent
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Scemblix therapy
Approval duration
12 months