Coverage is subject to the specific terms of the member’s benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the www.fepblue.org website.
Carfilzomib (Kyprolis) may be considered medically necessary when used for ANY of the following:
- In combination with dexamethasone or with lenalidomide plus dexamethasone or with daratumumab plus dexamethasone for the treatment of individuals with relapsed or refractory multiple myeloma who have received one to three lines of therapy; or
- As a single agent for the treatment of individuals with relapsed or refractory multiple myeloma who have received one or more lines of therapy; or
Carfilzomib (Kyprolis) may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.
Carfilzomib (Kyprolis) not meeting the criteria as indicated in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.