ZOLINZA (vorinostat)
Self-Administration - Oral
Indications for Prior Authorization:
- Indicated for treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL) who have progressive, persistent or recurrent disease on or following two systemic therapies.
Coverage Criteria:
For diagnosis of Cutaneous T-cell Lymphoma:
- Dose does not exceed 400 mg daily, AND
- Patient is 18 years old or older, AND
- Prescribed by or in consultation with a hematologist/oncologist, AND
- One of the following:
- Patient has progressive, persistent or recurrent disease on or following 2 systemic therapies (e.g., extracorporeal photopheresis [ECP], systemic retinoids, interferons, etc.), OR
- History of contraindication or intolerance to other systemic therapies (e.g., Adcetris [brentuximab vedotin, Cytoxan [cyclophosphamide], Poteligeo [mogamulizumab], etc.)
Reauthorization Criteria:
For diagnosis of Cutaneous T-cell Lymphoma:
- Dose does not exceed 400 mg daily; AND
- Patient does not show evidence of progressive disease while on therapy
Coverage Duration:
- Initial: 1 year
- Reauthorization: 1 year
Dosing:
For diagnosis of Cutaneous T-cell Lymphoma:
- 400 mg orally once daily with food
Authorization is not covered for the following:
The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.
Additional Information:
- Drug interactions
- Coumarin-derivative anticoagulants: monitor carefully
- Zolinza capsules should not be opened or crushed
Policy Updates:
- 11/16/2021 – New policy approved by P&T.
References:
- Zolinza Prescribing Information. Merck & Co, Inc. Whitehouse Station, NJ. January 2020.
- National comprehensive cancer network (NCCN) clinical practice guidelines in oncology: Primary cutaneous lymphomas. v.2.2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/primary_cutaneous.pdf. Accessed September 16, 2019.
Last review date: November 16, 2021