Multiple Myeloma:
Age Requirement: >= 18
Duration: 6 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: Payer Specific
ECOG Score Requirement in Policy: N/A
ECOG status <=2: No
Diagnosis Types: 1 of in combination with bortezomib and dexamethasone after at least one prior therapy;in combination with bortezomib, melphalan and prednisone in newly diagnosed disease ineligible for autologous stem cell transplant;in combination with lenalidomide and dexamethasone for the treatment multiple myeloma after at least one prior therapy. ;in combination with lenalidomide and dexamethasone in newly diagnosed disease ineligible for autologous stem cell transplant ;in combination with pomalidomide and dexamethasone for the treatment of multiple myeloma after at least two prior therapies including lenalidomide and a proteasome inhibitor.
Concomitant Therapy Requirement: 1 of Bortezomib, melphalan, prednisone (VMP);in combination with bortezomib and dexamethasone;In combination with Bortezomib, Thalidomide, and Dexamethasone;in combination with carfilzomib and dexamethasone;in combination with lenalidomide and dexamethasone;in combination with pomalidomide and dexamethasone