Exkivity (mobocertinib) — CareFirst (Caremark)
Locally advanced, recurrent, or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations whose disease has progressed on or after platinum-based chemotherapy
Initial criteria
- Member has locally advanced, recurrent, or metastatic disease
- Member has EGFR exon 20 insertion mutations confirmed by an FDA-approved test
- Disease has progressed on or after platinum-based chemotherapy
- Requested medication is used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity
- No evidence of disease progression while on the current regimen
Approval duration
12 months