Inrebic (fedratinib)
Indications for Prior Authorization
Inrebic (fedratinib)
-
For diagnosis of Myelofibrosis
Indicated for the treatment of adult patients with intermediate-2 or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis (MF).
Criteria
Inrebic
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
- Diagnosis of one of the following:
- Primary myelofibrosis
- Post-polycythemia vera myelofibrosis
- Post-essential thrombocythemia myelofibrosis
Inrebic
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
- Documentation of positive clinical response to therapy (e.g., symptom improvement, spleen volume reduction)
P & T Revisions
2024-09-02, 2023-09-01, 2023-07-03, 2022-09-23, 2022-05-20, 2021-09-17, 2020-08-12, 2019-10-03
References
- Inrebic Prescribing Information. Celgene Corporation. Summit, NJ. July 2024.
Revision History
- 2024-09-02: Annual review 2024. No criteria changes. Background updates only.
- 2023-09-01: Annual review: No criteria changes. Updated references.
- 2023-07-03: Removed specialist requirement
- 2022-09-23: Annual review: no criteria changes.
- 2022-05-20: Update Guideline
- 2021-09-17: 2021 annual review: no changes.
- 2020-08-12: Annual review - no changes.
- 2019-10-03: New program.
HEALTHY LIVING