Lorbrena — CareFirst (Caremark)
ALK-positive inflammatory myofibroblastic tumor (IMT)
Initial criteria
- Diagnosis of ALK-positive inflammatory myofibroblastic tumor (IMT)
- Used as a single agent
- Either (a) uterine sarcoma that is advanced, recurrent, metastatic, or inoperable OR (b) soft tissue sarcoma (not including uterine sarcoma)
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months