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Drug - Calquence® (acalabrutinib) [AstraZeneca Pharmaceuticals]

July 2018

Therapeutic area - Oral Oncology

Initial approval criteria

  • Patient must be at least 18 years of age AND
  • Patient must have a diagnosis of advanced mantle cell lymphoma AND
  • Patient must be using acalabrutinib as single agent AND
  • Patient must have received at least 1 prior therapy for mantle cell lymphoma AND
  • NOT have received any prior treatment with a BTK inhibitor (acalabrutinib or ibrutinib)
  • Initial approval will be for 6 months

Renewal criteria

  • Patient must continue to meet the above criteria AND
  • Patient must have documented efficacy with stabilization of disease or decrease in size of tumor or tumor spread AND
  • Patient must NOT have unacceptable adverse effects (e.g., anemia, thrombocytopenia, headache, neutropenia, diarrhea, fatigue, myalgia, and bruising)
  • Renewal approval will be for 6 months

Quantity limits

  • 68 capsules per 34 days


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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