UnitedHealthcare
Darzalex (daratumumab)
Drugs for Cancer : Drugs for Cancer
  • Multiple Myeloma:
    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: Payer Specific
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: 1 of Double refractory to a PI and an immunomodulatory agent;Monotherapy after at least 3 prior lines of therapy including a PI and an immunomodulatory agent;newly diagnosed and ineligible for autologous stem cell transplant;patients who have received at least one prior therapy;patients who received at least 2 prior therapies including lenalidomide and a proteasome inhibitor
    Concomitant Therapy Requirement: 1 of in combination with bortezomib and dexamethasone;in combination with bortezomib, melphalan and prednisone;in combination with lenalidomide and dexamethasone;in combination with pomalidomide and dexamethasone
    Policy Allows for Use as Combination Therapy: Yes
    Policy Allows for Use Monotherapy Therapy: Yes

  • Prior Authorization: Multiple Myeloma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes