Alecensa (alectinib) — CareFirst (Caremark)
Erdheim-Chester Disease (ECD)
Initial criteria
- Authorization may be granted for treatment of symptomatic or relapsed/refractory ALK-positive Erdheim-Chester disease 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