Formulary restrictions:

• Service Line: Hematology/Oncology
• Formulary Location: Inpatient, Outpatient Infusion
• Service location: Inpatient, Outpatient Infusion
• Patient population: Adults
• Prior authorization required: Yes for outpatient, single case agreement will be needed based on payor
• Criteria of use (all will apply unless specified):
• Multiple myeloma, relapsed/refractory who received 4 or more prior lines of therapy
• Radiographically documented disease
• No history of CNS disease
• No ongoing treatment with chronic immunosuppression or documented active infections
• Adequate bone marrow, renal, hepatic, pulmonary, and cardiac function (consistent with CARTITUDE-1 requirements)
• Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1
• Negative pregnancy test
• Healthcare facilities that dispense and administer CARVYKTI must be enrolled and comply with the CARVYKTI REMS requirements.            

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