Tabrecta (capmatinib) — CareFirst (Caremark)
Metastatic NSCLC with high-level MET amplification
Initial criteria
- Diagnosis of recurrent, advanced, or metastatic non-small cell lung cancer (including brain metastases from NSCLC) with MET exon 14 skipping mutation or high-level MET amplification confirmed by an FDA-approved test
- The requested medication will be used as a single agent
- For MET exon 14 skipping positive tumors: member has not experienced disease progression on therapy with another MET exon 14 skipping mutation-targeted regimen
Reauthorization criteria
- Continuation of therapy is approved when there is no evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months