Lytgobi (futibatinib) — CareFirst (Caremark)
Unresectable, resected gross residual (R2) disease, locally advanced, or metastatic intrahepatic cholangiocarcinoma harboring FGFR2 gene fusions or rearrangements
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