Afinitor Disperz — CareFirst (Caremark)
Gastrointestinal stromal tumor (GIST)
Initial criteria
- Residual, unresectable, recurrent, metastatic, or tumor rupture GIST
- Requested in combination with imatinib, sunitinib, or regorafenib
- Member has failed at least four FDA-approved therapies (e.g., imatinib, sunitinib, regorafenib, ripretinib)
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months