Pralatrexate (CPB 0740, reviewed 2026-09-10)
Summary
Aetna's clinical policy bulletin for pralatrexate (Folotyn or generic pralatrexate) considers it 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 are met. Most of these indications require use as a single agent, and several also set line-of-therapy or response requirements. Continuation is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression, and all other indications, including multiple myeloma, non-small cell lung carcinoma and solid tumors, are considered experimental, investigational, or unproven.
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