INQOVI (decitabine and cedazuridine)

INQOVI (decitabine and cedazuridine)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

• Indicated for the treatment of adults with myelodysplastic syndrome (MDS), including previously treated and untreated, de novo and secondary MDS with the following French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, and chronic myelomonocytic leukemia [CMML]) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups

Patients must meet the following criteria for the indication(s) above:

• Initial Criteria:
  • Diagnosis of seizures myelodysplastic syndrome, AND
  • Prescribed by or in consultation with a hematologist/oncologist, AND
  • Patient has ONE of the following French-American-British subtypes:
    • Refractory anemia
    • Refractory anemia with ringer sideroblasts
    • Refractory anemia with excess blasts
    • Chronic myelomonocytic leukemia (CMML)
• Reauthorization criteria:
  • Documentation showing absence of disease progression while on therapy

Dosing:

• 1 tablet once daily on days 1 through 5 of each 28-day treatment cycle for a minimum of 4 cycles, until disease progression or unacceptable toxicity

Coverage Duration:

• Initial:
  • 1 year
• Reauthorization:
  • 1 year

Authorization is Not Covered for the Following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

Review History:

• October 7, 2020 - Original review

References:

• Dacogen prescribing information. Astex Pharmaceuticals, Inc. Dublin, CA. February 2020.
• National Comprehensive Cancer (NCCN) Drugs & Biologics Compendium [internet database]. National Comprehensive Cancer Network, Inc. 2020. Updated periodically. Accessed June 12, 2020.
• Inqovi prescribing information. Astex Pharmaceuticals, Inc. Dublin, CA. July 2020.