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DrugYervoy (ipilimumab) [Bristol-Myers Squibb]

January 2016

Therapeutic area - Oncology

Approval criteria

The following criteria apply:

  • Patient has unresectable or metastatic melanoma AND
  • Patient has previously been treated with one or more of the following: aldesleukin, dacarbazine, temozolomide, fotemustine, or carboplatin AND
  • Prescriber provides weight of patient and dose of Yervoy being requested; doses >3 mg/kg will not be approved

Length of Approval

  • Three months

Additional information

Yervoy is a human cytotoxic T-lymphocyte antigen 4 (CTLA-4)-blocking antibody indicated for the treatment of unresectable or metastatic melanoma. FDA approved dosing for Yervoy is 3 mg/kg administered intravenously over 90 minutes every three weeks for a total of four doses. Doses greater than 3mg/kg will not be approved. Documentation of patient weight and dose is required for approval.

Patient Program available
Providers who need to prescribe Yervoy at the 10mg/kg dose for the adjuvant treatment of fully resected stage III melanoma (lymph node > 1mm) may enroll their eligible patients in Bristol-Myers Squibb's (BMS) Adjuvant Patient Program for Melanoma by contacting BMS Access Support Center at 800-861-0048 (Monday-Friday 8:00 a.m. to 8:00 p.m. ET) or visiting


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

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