Pharmacy Prior Authorization Criteria

Ninlaro (ixazomib citrate)

For diagnosis of Multiple Myeloma
Indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy.
Limitations of Use: NINLARO is not recommended for use in the maintenance setting or in newly diagnosed multiple myeloma in combination with lenalidomide and dexamethasone outside of controlled clinical trials

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

2024-02-12, 2023-07-03, 2023-06-05, 2023-03-02, 2022-06-01, 2022-03-02, 2021-09-27, 2021-05-21, 2021-03-02, 2020-02-27

Ninlaro Prescribing Information. Takeda Pharmaceutical Company Limited. Cambridge, MA. November 2022.
The NCCN Drugs and Biologics Compendium (NCCN Compendium™). Available at http://www.nccn.org. Accessed 12 February, 2024

2024-02-12: 2024 annual review. No changes.
2023-07-03: Removed specialist requirement
2023-06-05: Program update to remove requirement that drug must be used in combination with other agents and use of prior treatment criterions.
2023-03-02: 2023 Annual Review - updated references
2022-06-01: Updated background and references with indication update. No changes to criteria.
2022-03-02: Annual review - updated references.
2021-09-27: Addition of EHB formulary to guideline, no changes to criteria
2021-05-21: Addition of EHB formulary to guideline, no changes to criteria
2021-03-02: 2021 Annual Review
2020-02-27: Annual Review