Pomalidomide (Pomalyst®)


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

Recommended Dosing:

  • The recommended dose is 4 mg once daily on days one to 21 of a repeated 28 day cycle

Box warnings:

  • Embryo-fetal toxicity, venous thrombosis


One year


Last review date: December 2, 2013

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