Pomalidomide (Pomalyst®)

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

Recommended Dosing

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


One year

  • Box warnings for: embryo-fetal toxicity, venous thrombosis

Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: March 2013 Reviewed: December 2013