Prior authorization required

Prior authorization is required. Approvals may be granted for up to 12 months when indication- and regimen-specific criteria are met.

• Authorization decisions reference the medical policy manual criteria (effective 2026-07-31).
• Reauthorization may be granted for 12 months when there is no evidence of unacceptable toxicity or disease progression on the current regimen.

Lines of therapy considerations

Coverage depends on prior lines of therapy and the specific regimen requested. No single step-therapy sequence is mandated, but documentation of prior therapies is required to demonstrate eligibility under the applicable criteria.

• Relapsed/refractory multiple myeloma: single-agent use allowed after ≥1 prior line of therapy.
• Relapsed/refractory multiple myeloma: some combination regimens require ≥3 prior lines of therapy (see medical policy criteria).
• Transplant candidate primary or maintenance therapy uses have distinct regimen-specific criteria.

Genetic testing documentation

Submit documentation of genetic testing when applicable. Specifically, provide evidence of the presence of translocation t(11;14) when the requested regimen or indication requires it.

• Translocation t(11;14) documentation is required for requests involving combination therapy with venetoclax and dexamethasone.
• Include test name, date, result, and interpreting laboratory report in the prior authorization submission.

Experimental/Investigational Exclusion

Use of this medication for indications not listed as FDA-approved or compendial uses (including those not supported by the policy criteria) is considered experimental/investigational and is not medically necessary.

• Compendial uses listed include multiple myeloma, systemic light chain amyloidosis, Waldenström macroglobulinemia/lymphoplasmacytic lymphoma, POEMS syndrome, MGRS, and MIDD.
• All other indications will be denied as experimental/investigational.