Lytgobi (futibatinib) — CareFirst (Caremark)

Initial criteria

• Member has unresectable, resected gross residual (R2) disease, locally advanced, or metastatic cholangiocarcinoma
• Tumor has FGFR2 gene fusion or rearrangement documented
• Used as a single agent
• Member has received prior treatment (subsequent treatment setting)

Reauthorization criteria

• Member is continuing treatment for an indication listed in the coverage criteria section
• No evidence of unacceptable toxicity while on current regimen
• No evidence of disease progression while on current regimen

Approval duration

12 months