Sarclisa®

Drug - Sarclisa® (isatuximab-irfc) [Sanofi]

September 2020

Therapeutic Area - Oncology

Initial approval criteria

Patient must be ≥ 18 years of age AND
Patient must have a diagnosis of multiple myeloma AND
Patient has received prior treatment with lenalidomide (Revlimid) AND a proteasome inhibitor (bortezomib [Velcade], carfilzomib [Kyprolis], OR ixazomib [Ninlaro]) AND
Patient will be receiving concomitant therapy with pomalidomide (Pomalyst®) and dexamethasone AND
Prior authorization requests for Pomalyst AND Sarclisa must be submitted concurrently AND
Patient has NOT failed treatment with previous anti-CD38 therapy (e.g., daratumumab [Darzalex]) AND
Patient does NOT have severe hypersensitivity to isatuximab-irfc or any other components AND
In females of childbearing potential, pregnancy has been ruled out prior to treatment AND contraception will be used during treatment and for ≥ 5 months after treatment
Initial approval is for 6 months

Patient must continue to meet the above criteria AND
Patient must have disease improvement and/or stabilization AND
Patient has NOT experienced any treatment-restricting adverse effects (e.g., severe infusion reactions including anaphylactic reactions, neutropenia, secondary primary malignancies)
Renewal approval is for 6 months

Sarclisa must be billed as a medical claim.

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