Alecensa (alectinib capsules – Genentech) — Cigna
Pediatric Diffuse High-Grade Gliomas
Initial criteria
- Patient age ≤ 21 years
- Patient has anaplastic lymphoma kinase (ALK)-positive disease
- Patient meets ONE of the following: medication is used for adjuvant treatment AND tumor is not diffuse midline glioma, H3 K27-altered or pontine location OR medication is used for recurrent or progressive disease
Approval duration
1 year