Alecensa (alectinib) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of ALK-positive IMT as a single agent when either of the following criteria are met:
• — The member has uterine sarcoma and the disease is advanced, recurrent, metastatic, or inoperable.
• — The member has a soft tissue sarcoma (not including uterine sarcoma).

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