UnitedHealthcare
Xpovio (100 MG Once Weekly) (selinexor)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limits Apply
  • Prior Authorization: Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Orally administered anticancer medication.
  • Diffuse Large B-Cell Lymphoma:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Multiple Myeloma:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: NCCN Guidelines
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: 1 of All NCCN indications with evidence level of 2A or higher;in combination with dexamethasone for the treatment of relapsed or refractory multiple myeloma who have received at least four prior therapies and refractory to at least two proteasome inhibitors at least two immunomodulatory agents,and an anti-CD38 monoclonal antibody
    Concomitant Therapy Requirement: in combination with dexamethasone