Mitoxantrone

Mitoxantrone is covered for specified FDA‑approved uses (secondary progressive, progressive relapsing and worsening relapsing MS — not primary progressive MS; hormone‑refractory metastatic prostate cancer with corticosteroids; initial therapy for acute nonlymphocytic leukemia) and for listed compendial oncology indications, with indication‑specific restrictions (e.g., certain NHL subtypes, pediatric solid tumors only in children, head/neck single‑agent use) and a cumulative lifetime dose limit of 140 mg/m2. Coverage requires documentation of the FDA or compendial diagnosis, baseline cardiac assessment (history/physical/ECG) with quantitative LVEF above the lower limit of normal and LVEF monitoring prior to each dose (annual after stopping for MS), baseline neutrophil count ≥1,500 cells/mm3, documentation of cumulative dose, and evidence of required concomitant therapy when indicated (eg, corticosteroids for prostate cancer; combination regimens for ANLL/lymphomas).