Added criteria for new FDA-approved indication of relapsed or refractory LBCL in adult patients – added criterion that disease is relapsed or refractory, added option that member is not a candidate for CAR T-cell therapy; per NCCN for B-cell lymphomas – added pathway for off-label use as a single agent or in combination with rituximab or nivolumab, clarified use in HIV-related B-cell lymphoma and PTLD are off-label indications.
CP.PHAR.488
Apomorphine (Apokyn, Apokyn NXT, Onapgo)
7/01/2025
Added new formulations Apokyn NXT and Onapgo to policy; added generic apomorphine to policy requiring PA; for Apokyn or Apokyn NXT, added must use generic apomorphine language; revised “prescribed concurrently with an anti-Parkinson agent” to “prescribed concurrently with levodopa/carbidopa”; added rqeuirement for trial and failure of at least two anti-Parkinson agents from different therapeutic classes, unless clinically significant adverse events are experienced or all are contraindicated.
CP.PHAR.549
Sotorasib (Lumakras)
07/01/2025
Added new FDA-approved indication of CRC and removed requirement for previous use of a fluoropyrimidine- (e.g., 5-fluorouracil, capecitabine), oxaliplatin-, and irinotecan-containing chemotherapy per NCCN and as Appendix B now lists previous CRC regimens; removed colon, appendiceal, and rectal cancers from NCCN-recommended off-label uses section as these are now encompassed within the CRC section; for NCCN-recommended off-label uses, added requirements for positive KRAS G12C mutation, previous therapy, and Lumakras monotherapy use per NCCN Compendium; for ampullary adenocarcinoma, added requirement for disease progression per NCCN; for small bowel adenocarcinoma, added requirement for advanced or metastatic disease per NCCN; for pancreatic adenocarcinoma, added requirement for locally advanced, recurrent, or metastatic disease; for NSCLC, added monotherapy requirement.
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