Tazverik (tazemetostat) — United Healthcare

Initial criteria

• Diagnosis of relapsed or refractory follicular lymphoma
• One of the following: (a) Subsequent therapy in EZH2 mutation positive disease after 2 prior therapies OR (b) Second-line therapy irrespective of EZH2 mutation status for older or infirm patients with indications for treatment (other therapy options not expected to be tolerable) OR (c) Third-line and/or subsequent therapy (if not previously given) irrespective of EZH2 mutation status in patients with indications for treatment

Reauthorization criteria

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

Approval duration

12 months