Pharmacy Prior Authorization Criteria

Xpovio (selinexor)

For diagnosis of Multiple Myeloma
1) Indicated in combination with bortezomib and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy.
2) Indicated in combination with dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma (RRMM) who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody.
For diagnosis of Diffuse Large B-cell Lymphoma (DLBCL)
Indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma, after at least 2 lines of systemic therapy.

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of All Indications

2024-05-30, 2023-07-18, 2023-06-07, 2022-06-16, 2021-06-01, 2021-02-03, 2020-07-28, 2019-08-21

Xpovio Prescribing Information. Karyopharm Therapeutics Inc. Newton, MA. July 2022.

2024-05-30: 2024 annual review. GPI clean up. No changes to clinical intent.
2023-07-18: Removed Oncology specialist requirement
2023-06-07: Annual review: Program update to consolidate Multiple Myeloma and Diffuse Large B Cell Lymphoma criteria into one criteria set that asks for diagnosis and prescriber requirement only. All other criteria removed.
2022-06-16: Annual review - updated references.
2021-06-01: Added GPIs for new Xpovio tablet packs.
2021-02-03: Added new indication for multiple myeloma. Updated background and references.
2020-07-28: New indication for DLBCL. Added new GPIs. Removed drug name from reauth criteria for consistency. Updated background and references.
2019-08-21: New PA for Xpovio.