Ayvakit (avapritinib) — CareFirst (Caremark)

Initial criteria

• Member has residual, unresectable, tumor rupture, recurrent/metastatic or progressive disease AND disease harbors a platelet-derived growth factor receptor alpha (PDGFRA) exon 18 mutation that is insensitive to imatinib, including PDGFRA D842V mutation AND Ayvakit will be used as a single agent for first-line therapy
• OR member has residual, unresectable, tumor rupture or recurrent/metastatic disease AND has failed at least four FDA-approved therapies (e.g., imatinib, sunitinib, regorafenib, ripretinib) AND Ayvakit will be used as a single agent
• OR Ayvakit will be used for neoadjuvant therapy to decrease surgical morbidity AND disease harbors a PDGFRA exon 18 mutation that is insensitive to imatinib, including PDGFRA D842V mutation AND Ayvakit will be used as a single agent

Reauthorization criteria

• Member is receiving clinical benefit and there is no evidence of generalized (widespread, systemic) disease progression or unacceptable toxicity while on the current regimen

Approval duration

12 months