afatinib — CareFirst (Caremark)
Metastatic non-small cell lung cancer (NSCLC) with EGFR-sensitizing mutation-positive disease
Initial criteria
- Diagnosis of recurrent, advanced or metastatic non-small cell lung cancer (NSCLC)
 - Disease is EGFR-sensitizing mutation-positive confirmed by an FDA-approved test
 - Used as a single agent or in combination with cetuximab OR
 - Diagnosis of metastatic squamous NSCLC progressing after platinum-based chemotherapy
 
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen OR
 - Disease is T790M negative and there is no evidence of unacceptable toxicity
 
Approval duration
12 months