Kyprolis is considered medically necessary for patients who meet all of the
following criteria:
1)
Diagnosis of multiple
myeloma (C90.00, C90.02) AND
2)
For previously treated
multiple myeloma for relapsed and refractory disease, Kyprolis is prescribed in
one of the following ways (a, b, or c):
a.
In combination with
dexamethasone or with Revlimid (lenalidomide) plus dexamethasone in patients who
have received oneo r three lines of therapy;
b.
As a single agent in
patients who have received one or more lines of therapy;
c.
In combination with
Darzalex (daratumumab) and dexamethasone in patients who have received one or
three lines of therapy;
OR
3)
Will be used with Revlimid (lenalidomide)
and dexamethasone as first-line treatment of multiple myeloma.
OR
4)
Will be used with
dexamethasone and cyclophosphamide as first-line treatment of multiple myeloma.
Kyprolis is also considered medically necessary for patients who meet all the
following critera:
1)
Diagnosis of
Waldenstrom’s macroglobulinemia (i.e., lymphoplasmacytic lymphoma) (WM/LP);
2)
Prescribed by or in
consultation with an oncologist;
3)
Age 18 years or older;
4)
Prescribed as a component
of CaRD (carfilzomib, Rituxan [rituximab), and dexamethasone regimen as primary
or Kyprolis-relapsed therapy
Codes
Used In This BI:
J9047 Injection, carfilzomib, 1mg