Turalio (pexidartinib)
Indications for Prior Authorization
Turalio (pexidartinib)
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For diagnosis of Tenosynovial Giant Cell Tumor (TGCT)
Indicated for the treatment of adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery.
Criteria
Turalio
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
- Diagnosis of tenosynovial giant cell tumor (TGCT) AND
- Patient is symptomatic AND
- Patient is not a candidate for surgery due to worsening functional limitation or severe morbidity with surgical removal
Turalio
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
- Patient does not show evidence of progressive disease while on therapy
P & T Revisions
2024-07-12, 2023-11-01, 2023-06-26, 2023-02-07, 2022-08-15, 2021-09-07, 2021-05-26, 2021-05-25, 2021-04-09, 2020-08-27, 2019-09-18
References
- Turalio prescribing information. Daiichi Sankyo, Inc. Basking Ridge, NJ. November 2023.
Revision History
- 2024-07-12: 2024 Annual Review, no changes.
- 2023-11-01: Annual Review, no changes.
- 2023-06-26: Removed specialist requirement.
- 2023-02-07: Added new Turalio 125mg capsule to existing criteria
- 2022-08-15: 2022 Annual Review - No changes to criteria, background updates
- 2021-09-07: Annual Review
- 2021-05-26: Addition of EHB formulary to guideline, no changes to criteria
- 2021-05-25: Addition of EHB formulary to guideline, no changes to criteria
- 2021-04-09: Updated GPIs
- 2020-08-27: Annual Review: removed drug name from reauth, references updated
- 2019-09-18: New program
HEALTHY LIVING