brigatinib — CareFirst (Caremark)
Inflammatory myofibroblastic tumor (IMT) with ALK translocation
Initial criteria
- Diagnosis of ALK-positive inflammatory myofibroblastic tumor (IMT)
- Used as a single agent
- Either the member has uterine sarcoma with advanced, recurrent, metastatic, or inoperable disease OR the member has a soft tissue sarcoma (not including uterine sarcoma)
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months