Health Net
Calquence (acalabrutinib maleate)
Drugs for Cancer : Drugs for Cancer
  • Step Therapy: Chronic Lymphocytic Leukemia:
    ST Single Generic

  • Chronic Lymphocytic Leukemia:
    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: = 1 plan year
    Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
    Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests
    Concomitant Therapy Requirement: obinutuzumab
    Diagnosis Types: 2 of as a single agent;Chronic Lymphocytic Leukemia;CLL for relapsed/refractory disease;patients with CLL who have received at least one prior therapy;Small Lymphocytic Lymphoma

  • Prior Authorization: Chronic Lymphocytic Leukemia:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes