Subject: Specialty Quantity Limit Xpovio 3120-H P2025a

Drug

XPOVIO  (selinexor)

Policy:

Program Description

The standard limit is designed to allow a quantity sufficient for the most common uses of the medication. The recommended dosing parameters for all FDA-approved indications fall within the standard limits. Coverage of an additional quantity may be reviewed on a case-by-case basis upon request.

Covered Quantities

Coverage up to the exception limits may be provided with prior authorization via the Specialty Post Limit Quantity Exception Criteria for approval.

Medication	Standard Limit
Xpovio (selinexor) 80 mg twice weekly carton	1 carton per 28 days (thirty-two 20 mg tablets per 28 days)
Xpovio (selinexor) 60 mg twice weekly carton	1 carton per 28 days (twenty-four 20 mg tablets per 28 days)
Xpovio (selinexor) 40 mg twice weekly carton	1 carton per 28 days (eight 40 mg tablets per 28 days)
Xpovio (selinexor) 100 mg once weekly carton	1 carton per 28 days (eight 50 mg tablets per 28 days)
Xpovio (selinexor) 80 mg once weekly carton	1 carton per 28 days (eight 40 mg tablets per 28 days)
Xpovio (selinexor) 80 mg once weekly carton	1 carton per 28 days (four 80 mg tablets per 28 days)
Xpovio (selinexor) 60 mg once weekly carton	1 carton per 28 days (four 60 mg tablets per 28 days)
Xpovio (selinexor) 40 mg once weekly carton	1 carton per 28 days (four 40 mg tablets per 28 days)
Xpovio (selinexor) 40 mg once weekly carton	1 carton per 28 days (sixteen 10 mg tablets per 28 days)

FDA-Recommended Dosing

Multiple myeloma (in combination with bortezomib and dexamethasone)

100 mg once weekly on day 1

Dose adjustments due to adverse reactions

• First reduction: 80 mg once weekly
• Second reduction: 60 mg once weekly
• Third reduction: 40 mg once weekly

Multiple myeloma (in combination with dexamethasone)

80 mg twice weekly on days 1 and 3

Dose adjustments due to adverse reactions

• First reduction: 100 mg once weekly
• Second reduction: 80 mg once weekly
• Third reduction: 60 mg once weekly

Diffuse large B-cell lymphoma

60 mg twice weekly on days 1 and 3

Dose adjustments due to adverse reactions

• First reduction: 40 mg twice weekly
• Second reduction: 60 mg once weekly
• Third reduction: 40 mg once weekly

Place of Service:

Outpatient

The above policy is based on the following references:

1. Xpovio [package insert]. Newton, MA: Karyopharm Therapeutics Inc.; October 2025.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

March 11, 2026