idelalisib (Zydelig®)


Indications for Prior Authorization:

  • Approvable for relapsed chronic lymphocytic leukemia (CLL),
  • Relapsed follicular B-Cell non-Hodgkin’s lymphoma, OR
  • Relapsed small lymphocytic lymphoma (SLL)

Patient must meet the following criteria for the above indications:

  • For CLL must be used in combination with rituximab
  • For B-cell non-Hodgkin’s lymphoma or SLL patients must have failed two prior systemic therapies

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

  • For any indications not mentioned above


  • Recommended maximum starting dose is 150 mg twice daily
  • Adjust dose downward for drug related toxicities such as diarrhea and increased liver enzymes


6 months


Last review date: September 1, 2014

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