Alecensa (alectinib) — CareFirst (Caremark)
Anaplastic Large Cell Lymphoma (ALCL)
Initial criteria
- Authorization may be granted for initial palliative therapy or treatment of relapsed/refractory ALK-positive ALCL as a single agent.
Reauthorization criteria
- Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Approval duration
12 months