POMALYST (pomalidomide)

POMALYST (pomalidomide)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

• Treatment of adult patients with multiple myeloma who have received at least two prior therapies including lenalidomide and a proteasome inhibitor and have demonstrated disease progression on or within 60 days of completion of the last therapy

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

• Chart note documentation from the following specialist is provided confirming diagnosis, AND
• Patient is 18 years of age or older, AND
• Patients must have received two prior therapies including lenalidomide (Revlimid®) and bortezomib (Velcade®) and have had disease progression within 60 days of completion of the last therapy

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

• All non-FDA approved uses not listed in the approved indications
• Patient must be pregnant or attempting to become pregnant

Recommended Dosing:

• The recommended dose is 4 mg once daily on days one to 21 of a repeated 28 day cycle
• Pomalyst should be given in combination with dexamethasone

Box warnings:

• Embryo-fetal toxicity, venous thrombosis

Approval:

One year