Avmapki Fakzynja Co-Pack — CareFirst (Caremark)
KRAS-mutated recurrent low-grade serous ovarian cancer (LGSOC)
Initial criteria
- Diagnosis of KRAS-mutated recurrent low-grade serous ovarian cancer (LGSOC)
- Member has received prior systemic therapy
- Submission of KRAS mutation documentation
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months