Gilotrif — CareFirst (Caremark)
Metastatic non-small cell lung cancer (NSCLC) with EGFR-sensitizing mutation-positive disease
Initial criteria
- Diagnosis of recurrent, advanced or metastatic non-small cell lung cancer (NSCLC)
- Disease is EGFR-sensitizing mutation-positive confirmed by an FDA-approved test
- Used as a single agent or in combination with cetuximab OR
- Diagnosis of metastatic squamous NSCLC progressing after platinum-based chemotherapy
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen OR
- Disease is T790M negative and there is no evidence of unacceptable toxicity
Approval duration
12 months