Gleevec — CareFirst (Caremark)
Cutaneous Melanoma
Initial criteria
- Disease is metastatic or unresectable
- Tumor has c-KIT activating mutations
- Requested medication will be used as subsequent therapy
- Member experienced disease progression, intolerance, or risk of progression with BRAF-targeted therapy
- Medication will be used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months