lazertinib — CareFirst (Caremark)
First-line treatment of recurrent, advanced, or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R substitution mutations in combination with amivantamab
Initial criteria
- Diagnosis of recurrent, advanced, or metastatic NSCLC
- Presence of EGFR exon 19 deletion or exon 21 L858R substitution mutation confirmed by test results
- Used in combination with amivantamab (Rybrevant)
- Requested for first-line treatment
Reauthorization criteria
- No evidence of unacceptable toxicity while on the current regimen
- Used for an indication listed in the coverage criteria section
Approval duration
12 months