Self administration- Oral
Indications for Prior Authorization
- Treatment of adult patients with multiple myeloma
Patients must meet the following criteria for the indication(s) above.
Patients must have received two prior therapies including lenalidomide (Revlimid®) and bortezomib (Velcade®) and have had disease progression within 60 days of completion of the last therapy.
The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee.
- All non-FDA approved uses not listed in the approved indications
- Patient must be pregnant or attempting to become pregnant
- The recommended dose is 4 mg once daily on days one to 21 of a repeated 28 day cycle.
- Box warnings for: embryo-fetal toxicity, venous thrombosis
Western Health Advantage Pharmacy and Therapeutics Committee
Approved/Revised: March 2013 Reviewed: December 2013