Phyrago — CareFirst (Caremark)
Gastrointestinal Stromal Tumor (GIST)
Initial criteria
- Member has residual, unresectable, progressive, tumor rupture, or recurrent/metastatic disease
- Disease harbors a PDGFRA exon 18 mutation
- Member has received prior therapy with avapritinib
- Requested medication will be used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity while on current regimen
Approval duration
12 months