Pralatrexate (CPB 0740, reviewed 2025-09-11)
Summary
Aetna considers pralatrexate (Folotyn or generic pralatrexate) medically necessary for adult T-cell leukemia/lymphoma, breast implant-associated anaplastic large cell lymphoma, cutaneous anaplastic large cell lymphoma, extranodal NK/T-cell lymphoma, hepatosplenic T-cell lymphoma, mycosis fungoides or Sezary syndrome, peripheral T-cell lymphoma, and subcutaneous panniculitis-like T-cell lymphoma when the listed criteria for each indication are met. Continuation of therapy is considered medically necessary for these indications when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Aetna considers pralatrexate experimental, investigational, or unproven for all other indications, including esophagogastric cancer, head and neck squamous cell cancer, multiple myeloma, non-small cell lung carcinoma, pleural mesothelioma and solid tumors.
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