TIBSOVO (ivosidenib)

TIBSOVO (ivosidenib) 

SELF ADMINISTRATION

Indications for Prior Authorization:

• Treatment of adult patients with relapsed or refractory Acute Myeloid Leukemia (AML) with a susceptible isocitrate dehydrogenase-1 (IDH1) mutation as detected by an FDA-approved test

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 relapsed or refractory AML as confirmed by chart note documentation, AND
• Patient is isocitrate dehydrogenase-1 (IDH1) mutation positive as confirmed by an FDA-approved test, AND
• Prescribed by or in consultation with an oncologist, AND
• Will not be used with strong CYP3A4 inducers, sensitive CYP3A4 substrates, and QT prolonging drugs (when possible)

Dosing:

• 500mg once daily

Approval:

• 1 year