Jaypirca Drug Quantity Management Policy
Defines quantity limits and medical necessity exceptions for Jaypirca (pirtobrutinib) 50 mg and 100 mg tablets, including expanded per-dispensing quantities when patients are taking CYP3A inducers or inhibitors. Applies to Cigna-administered health benefit plans subject to plan terms.
Jaypirca 50mg tablets: Criteria was added to approve 90 tablets per dispensing at retail or 270 tablets at home delivery if the patient is taking a strong CYP3A inhibitor.
Updated the note for CYP3A inducers to remove ritonavir.
Jaypirca 50mg and 100mg tablets: criteria for approving 90 tablets retail / 270 home delivery when taking a moderate or strong CYP3A inducer (and for 50mg when taking a strong CYP3A inhibitor) are present.
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