Romidepsin (CPB 0865, reviewed 2026-04-17)
Summary
Aetna's Clinical Policy Bulletin 0865 covers romidepsin (Istodax or generic romidepsin) for commercial medical plans when it treats cutaneous T-cell lymphoma, including mycosis fungoides, Sézary syndrome, primary cutaneous anaplastic large cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma, or peripheral T-cell lymphoma. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications, including acute myeloid leukemia, chronic lymphocytic leukemia, multiple myeloma and breast cancer, are considered experimental, investigational, or unproven.
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