Pemazyre (pemigatinib) — CareFirst (Caremark)

Initial criteria

• Member has progressive, unresectable, resected gross residual (R2) disease or metastatic cholangiocarcinoma
• Disease has a fibroblast growth factor receptor 2 (FGFR2) fusion or rearrangement documented by an FDA-approved test
• Pemazyre will be used as a single agent

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on current regimen

Approval duration

12 months