Zolinza — United Healthcare

Initial criteria

• Diagnosis of cutaneous T-cell lymphoma (CTCL)
• AND
• Patient has progressive, persistent, or recurrent disease on or following two systemic therapies (e.g., Adcetris [brentuximab vedotin], bexarotene, interferon alfa-db, interferon gamma-1b, methotrexate, Poteligeo [mogamulizumab], romidepsin)

Reauthorization criteria

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

Approval duration

12 months