Duvelisib (Copiktra™)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Indicated for the treatment of adult patients with:
    •  Relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) after at least two prior therapies
    • Relapsed or refractory follicular lymphoma (FL) after at least two prior systemic therapies

Patients must meet the following criteria for the indication(s) above:

  • Patient is 18 years of age or older, AND
  • Patient has a diagnosis of chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), or small lymphocytic lymphoma (SLL), AND
  • Patient has tried and failed at least two prior systemic therapies, AND
  • Prescribed by an oncologist, AND
  • Copiktra™ will not be used in combination with strong CYP3A inducers

Dosing: 

  • 25mg capsules taken twice daily

Approval: 

  • 1 year 

Last review date: September 3, 2019

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