Pharmacy Prior Authorization Criteria

Komzifti (ziftomenib)

Indications for Prior Authorization

Komzifti (ziftomenib)

• For diagnosis of Relapsed or Refractory Acute Myeloid Leukemia
  Indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with a susceptible nucleophosmin 1 (NPM1) mutation who have no satisfactory alternative treatment options.

Criteria

Komzifti

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

• Diagnosis of acute myeloid leukemia (AML)
AND
• Disease is relapsed or refractory
AND
• Presence of a susceptible nucleophosmin 1 (NPM1) mutation as detected by an FDA-approved test or a test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)

Komzifti

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

• Patient does not show evidence of progressive disease while on therapy

P & T Revisions

2026-01-07

References

1. Komzifti Prescribing Information. Kura Oncology, Inc. San Diego, CA. November 2025.

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Revision History

• 2026-01-07: New Program

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