Zolinza (vorinostat)
Indications for Prior Authorization
Zolinza (vorinostat)
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For diagnosis of Cutaneous T-cell Lymphoma
Indicated for treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL) who have progressive, persistent or recurrent disease on or following two systemic therapies.
Criteria
Zolinza
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
- Diagnosis of cutaneous T-cell lymphoma AND
- One of the following: [2]
- Patient has progressive, persistent or recurrent disease on or following two systemic therapies (e.g., extracorporeal photopheresis [ECP], systemic retinoids, interferons) [A] OR
- History of contraindication or intolerance to other systemic therapies (e.g., Adcetris [brentuximab vedotin, Cytoxan [cyclophosphamide], Poteligeo [mogamulizumab]) [A]
Zolinza
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
- Patient does not show evidence of progressive disease while on therapy
P & T Revisions
2024-09-04, 2023-08-23, 2023-07-05, 2022-08-14, 2021-09-09, 2021-05-26, 2021-05-25, 2020-09-10, 2019-09-18
References
- Zolinza Prescribing Information. Merck & Co, Inc. Whitehouse Station, NJ. July 2022
- National comprehensive cancer network (NCCN) clinical practice guidelines in oncology: Primary cutaneous lymphomas. v.2.2024. Available at: https://www.nccn.org/professionals/physician_gls/pdf/primary_cutaneous.pdf. Accessed August 6, 2024.
Revision History
- 2024-09-04: 2024 Annual Review. No change to clinical intent. Formatting updates to criteria. Background updates
- 2023-08-23: 2023 Annual Review
- 2023-07-05: guideline update
- 2022-08-14: 2022 Annual Review
- 2021-09-09: 2021 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
- 2020-09-10: 2020 Annual Review: updated reauthorization criteria and references
- 2019-09-18: 2019 Annual Review. No clinical criteria changes.
HEALTHY LIVING