Chronic Lymphocytic Leukemia:
Age Requirement: >= 18
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests
Diagnosis Types: 2 of Chronic Lymphocytic Leukemia;Second-line treatment ;Small Lymphocytic Lymphoma

Diffuse Large B-Cell Lymphoma, Myelodysplastic Syndrome:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)

Follicular Lymphoma (FL):
Age Requirement: >= 18
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)

Mantle Cell Lymphoma, Non Hodgkin Lymphoma (NHL):
Age Requirement: >= 18
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year

Marginal Zone Lymphoma:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified

Multiple Myeloma:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
ECOG Score Requirement in Policy: N/A
ECOG status <=2: No
Diagnosis Types: 1 of All FDA-approved indications;All NCCN indications with evidence level of 2A or higher;As a single agent in steroid intolerant individuals with previously treated relapsed or progressive disease;as maintenance following autologous hematopoietic stem cell transplantation;Maintenance therapy as a single agent or in combination with bortezomib for active myeloma after response to primary therapy;Multiple Myeloma in combination with dexamethasone;patients who have received at least one prior therapy;Progressive disease;Relapsed disease
Concomitant Therapy Requirement: 1 of in combination with bortezomib;in combination with dexamethasone