repotrectinib — CareFirst (Caremark)

Initial criteria

• Member age ≥ 12 years
• Tumor has a confirmed NTRK gene fusion as demonstrated by laboratory testing (e.g., next-generation sequencing or fluorescence in situ hybridization)
• Tumor is locally advanced or metastatic or where surgical resection is likely to result in severe morbidity
• Tumor has progressed following treatment or has no satisfactory alternative therapy

Reauthorization criteria

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

Approval duration

12 months