Cutaneous T‑Cell Lymphomas (CTCL): Systemic Therapies
Defines medical necessity and coverage criteria for specific systemic and topical therapies used to treat cutaneous T‑cell lymphomas (including mycosis fungoides and Sézary syndrome) for Premera Blue Cross; applies to providers requesting pharmacy or medical benefit coverage for listed agents.
Updated initial authorization for all other reviews for all oral and topical drugs listed in the policy from 3 months to 6 months.
Removed use of Istodax (romidepsin) and romidepsin injection for the treatment of peripheral T-cell lymphoma due to withdrawal of that indication from the prescribing information.
Updated coverage criteria for oral and topical Targretin (bexarotene) to require trial and failure with generic bexarotene (capsules and topical) and added coverage criteria for generic topical bexarotene.
Non-formulary exception review authorizations for all drugs listed in this policy may be approved up to 12 months.
Added brand romidepsin injection to policy with identical coverage criteria as Istodax (romidepsin).
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.