Ponatinib (Iclusig®)


Indications for Prior Authorization:

  • Treatment of adult patients with chronic, accelerated, or blast phase chronic myeloid leukemia (CML)
  • Treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL)

Patients must meet the following criteria for the indication(s) above:

  • Patient is resistant or intolerant to prior tyrosine kinase inhibitor therapy
    • CML: Gleevec, Sprycel, Tasigna and Bosulif
    • Ph+ ALL: Gleevec and Sprycel
  • For ALL, patients must undergo genetic testing to confirm Ph+ status
  • Patient must not be pregnant or planning on becoming pregnant

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


  • 45 mg orally once a day

Box warnings: 

  • For arterial/venous thrombosis, hepatotoxicity, congestive heart failure, pancreatitis, cardiac arrhythmias and myelosuppression


One year or until disease progression or intolerable side effects


Last review date: December 2, 2013

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.

Press Esc to cancel

El sitio Web al que está siendo transferido no es provisto por WHA. Las Condiciones de Uso y las Prácticas de Privacidad en Internet de WHA no se aplican a este sitio Web asociado que usted está usando. Revise las políticas sobre la privacidad y condiciones de uso de este sitio Web asociado. WHA no tiene control sobre la exactitud, la totalidad o la actualidad del contenido del sitio Web asociado. WHA no puede garantizar que los servicios de traducción de idiomas estarán disponibles en el sitio vinculado.

Presione «Esc» para cancelar