CurrentNeighborhood Health Plan of Rhode IslandPolicy 2238-A

Idhifa Sgm 2238 A P2025

Defines coverage and prior authorization criteria for Idhifa (enasidenib) for adult patients with IDH2-mutated acute myeloid leukemia (AML), including FDA-approved and compendial uses, treatment settings (induction, post‑induction, relapsed/refractory), continuation criteria, required documentation, and authorization duration.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyIdhifa Sgm 2238 A P2025

Policy CodePolicy 2238-A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit medical record documentation confirming an IDH2 mutation (detected by an FDA‑approved test) to initiate prior authorization review

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes

1FDA‑approved indication (relapsed/refractory AML with IDH2 mutation)

3Compendial/covered use scenarios described

12Typical authorization duration (months)

Coverage Summary & Authorization

Scope: Defines coverage and prior authorization criteria for Idhifa (enasidenib) for adult patients with IDH2‑mutated acute myeloid leukemia (AML), including FDA‑approved and compendial uses across treatment settings (induction, post‑induction, relapsed/refractory), required documentation, and authorization duration. Coverage stance: covered_with_criteria. Policy number: 2238-A. Typical authorizations are for 12 months (including induction, post‑induction, relapsed/refractory, and continuation when criteria are met).