Zolinza Coverage Policy
Defines prior authorization recommendations, covered indications, duration of approval, and non-covered uses for Zolinza (vorinostat capsules) under Cigna-administered health benefit plans.
Classic Hodgkin Lymphoma: Added as a new condition for approval under Other Uses with Supportive Evidence section.
Annual review dated 07/02/2025 with no criteria changes noted in summary.
Coverage Summary & Indications
This policy defines coverage for Zolinza (vorinostat) under Cigna‑administered health benefit plans and the recommended prior authorization process. The policy stance is covered with criteria: Zolinza is covered for its FDA‑approved use for the cutaneous manifestations of cutaneous T‑cell lymphoma in patients with progressive, persistent, or recurrent disease following two systemic therapies, with approvals provided for 1 year. The policy also includes an Other Uses with Supportive Evidence pathway for Classic Hodgkin Lymphoma that provides coverage for 1 year when all specified criteria are met (patient ≥18 years, at least three prior systemic regimens, and vorinostat used in combination with pembrolizumab). The policy references the FDA prescribing information and NCCN guidance supporting these placements.
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