lorlatinib — CareFirst (Caremark)

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