CurrentCignaPolicy N/A

Oncology - Vonjo Prior Authorization Policy

Cigna prior authorization policy for Vonjo (pacritinib capsules) covering FDA-approved indication and selected supportive evidence uses for adult patients; applies to health benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyOncology - Vonjo Prior Authorization Policy

Policy CodePolicy N/A

Change TypeCriteria revised and new indications added

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization; approvals are provided for 1 year when criteria are met.

SourceLink

POLICY UPDATE CHANGES

For patients with platelet count <50 x10^9/L the qualifier changed from 'intermediate-risk or high-risk' to 'higher-risk disease' and transplant candidacy qualifier was removed.

Removed requirement for prior therapy for lower-risk patients with platelet count <50 x10^9/L and added option for approval for myelofibrosis-associated anemia with symptomatic splenomegaly and/or constitutional symptoms.

Conditions of approval and criteria were added for Accelerated or Blast Phase Myeloproliferative Neoplasm and Myeloid or Lymphoid Neoplasms with JAK2 rearrangement.

1 yearauthorization duration

≥18minimum age

<50platelet threshold

JAK2required biomarker

Coverage Criteria for Vonjo (pacritinib)

FDA-Approved: Myelofibrosis

Approve for 1 year if the patient meets BOTH of the following (A and B):

Notes: Examples of disease-related symptoms include: fatigue, fever, night sweats, weight loss, abdominal discomfort, splenomegaly, thrombocytosis, or leukocytosis.

Other Uses with Supportive Evidence

Approve for 1 year when specified criteria are met.

Accelerated/Blast Phase MPN: A) Patient is >= 18 years of age; AND B) Patient has at least one disease-related symptom

Myeloid or Lymphoid Neoplasms with JAK2 rearrangement: A) Patient is >= 18 years of age; AND B) Patient has eosinophilia; AND C) The tumor has a JAK2 rearrangement; AND D) Patient has tried Jakafi (ruxolitinib tablets)

Policy Summary

PayerCigna

PolicyOncology - Vonjo Prior Authorization Policy

Policy CodePolicy N/A

Change TypeCriteria revised and new indications added

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization; approvals are provided for 1 year when criteria are met.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Vonjo (pacritinib) is considered not medically necessary for any uses not specified in this policy. The policy’s covered indications include the FDA‑approved myelofibrosis indication and the listed Other Uses with Supportive Evidence; any additional uses will be evaluated and the criteria updated as new published data become available.

Any use(s) other than the FDA‑approved indication(s) or those listed under Other Uses with Supportive Evidence in this policy are considered not medically necessary. Providers seeking coverage for indications outside of those specified should expect denial unless and until the policy is revised to include the use based on new published evidence.

Regimen	Indication / Rationale	Notes
Vonjo (pacritinib) ± induction chemotherapy
Consider for myeloid/lymphoid neoplasms with eosinophilia and JAK2 rearrangement (chronic or blast phase)
Per NCCN, Vonjo may be combined with ALL- or AML-type induction chemotherapy and followed by allogeneic HCT if eligible; recommended when ruxolitinib (Jakafi) is unavailable or not tolerated (category 2A)

salvage

Salvage: Consider Vonjo for patients with myeloid/lymphoid neoplasms with JAK2 rearrangement when ruxolitinib (Jakafi) is unavailable or not tolerated; may be used in combination with induction chemotherapy and followed by allogeneic hematopoietic cell transplant if eligible.

Coding and Measurement Thresholds

Referenced billing guidancemixed

No codes listed

Platelet count threshold — < 50 × 10^9/L (< 50,000/mcL)

Platelet count threshold< 50 × 10^9/L (< 50,000/mcL)

Context of thresholdReferenced for FDA-approved myelofibrosis indication (patients with platelet count below 50 × 10^9/L)

Approval basisIndication approved under accelerated approval based on spleen volume reduction

Provider Requirements & Prior Authorization

Prior Authorization

Prior Authorization Recommended

Prior authorization is recommended for prescription benefit coverage of Vonjo. Approvals are provided for 1 year when criteria are met.

Vonjo (pacritinib) - prior authorization recommended
Approval duration: 1 year

Step Therapy

Required Prior Trial for Neoplasms Indication

For myeloid or lymphoid neoplasms with a JAK2 rearrangement, the patient must have tried Jakafi (ruxolitinib) prior to approval.

Indication: Myeloid or lymphoid neoplasms with JAK2 rearrangement
Required prior trial: Jakafi (ruxolitinib)

Prior Authorization

Prior Authorization and Approval Duration

Prior authorization is required for Vonjo; approvals are provided for the duration noted in the policy (typically 1 year when criteria are met).

Prior authorization required for prescription benefit coverage of Vonjo
Typical approval duration: 1 year

Billing Rule

Billing and Benefit Plan Conflicts

Claims submitted without covered diagnosis/procedure codes will be denied. Coverage is determined by the member's benefit plan; providers must bill using the most appropriate codes as of the date of service.

Claims without covered diagnosis/procedure codes will be denied
Coverage determined by applicable benefit plan document

Background on Vonjo (pacritinib)

Vonjo (pacritinib) is an oral kinase inhibitor with activity against JAK2 (and FLT3) that received accelerated approval for adults with intermediate‑ or high‑risk primary or secondary myelofibrosis with platelet counts <50 × 10^9/L, based on spleen volume reduction. Clinical guidance (NCCN) also describes uses in select myeloproliferative neoplasms and in JAK2‑rearranged myeloid/lymphoid neoplasms where it may be used when ruxolitinib is unavailable or not tolerated.

Definitions and Symptom Examples

accelerated approval — definition/label

DefinitionAccelerated approval: indication approved under an accelerated pathway; continued approval may be contingent upon verification and description of clinical benefit in confirmatory trial(s).

Regulatory contextApplied to Vonjo's myelofibrosis indication based on spleen volume reduction

ImplicationPostmarketing confirmatory trials may be required to verify clinical benefit for continued approval

disease-related symptom — examples

ExamplesFatigue; fever; night sweats; weight loss; abdominal discomfort; splenomegaly; thrombocytosis; leukocytosis.

Use in criteriaAt least one disease-related symptom is required for several approval pathways (e.g., myelofibrosis with platelet ≥50 × 10^9/L; accelerated/blast phase MPN).

Population relevanceApplied across FDA-approved and supportive-evidence indications in adults (≥18 years).

Biomarker Requirements for Specific Indications

JAK2 rearrangement — Required tumor biomarker for myeloid/lymphoid neoplasms indication

Required biomarkerJAK2 rearrangement

Indication tied to biomarkerRequired for the 'Myeloid or Lymphoid Neoplasms' supportive-evidence indication (tumor has a JAK2 rearrangement).

Additional requirementAlso requires eosinophilia and prior trial of Jakafi (ruxolitinib) per policy criteria for this indication.

Regimens and Combinations

Component	Details
Vonjo administration
Per regimen description in NCCN guidelines: Vonjo (pacritinib) as the targeted agent for JAK2-rearranged neoplasms
Induction chemotherapy
ALL- or AML-type induction chemotherapy when indicated for blast-phase disease; used in combination with Vonjo per NCCN guidance
Post-induction plan
Follow with allogeneic hematopoietic cell transplant (HCT) if patient is eligible
Use context
Recommendations apply specifically when ruxolitinib (Jakafi) is unavailable or not tolerated (NCCN category 2A)