Iclusig (ponatinib) — CareFirst (Caremark)

Initial criteria

• Used as a single agent for residual, unresectable, recurrent, or metastatic/tumor rupture GIST
• Disease has progressed on at least four FDA-approved therapies (e.g., imatinib, sunitinib, regorafenib, and ripretinib)

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on current regimen

Approval duration

12 months