Vitrakvi — CareFirst (Caremark)

Solid tumors with a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation that are metastatic or where surgical resection is likely to result in severe morbidity and have no satisfactory alternative treatments or have progressed following treatment

Initial criteria

Diagnosis of a solid tumor with an NTRK gene fusion without a known acquired resistance mutation, as demonstrated by laboratory testing such as next‑generation sequencing (NGS) or fluorescence in situ hybridization (FISH)
Tumor is metastatic or surgical resection is likely to result in severe morbidity
Member has no satisfactory alternative treatments or disease has progressed following treatment

Reauthorization criteria

Member is requesting reauthorization for an indication listed in the coverage criteria section
There is no evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months