Braftovi — Cigna
Non-Small Cell Lung Cancer, BRAF V600E mutation-positive disease
Preferred products
- Tafinlar
Initial criteria
- Approve for 1 year if the patient meets ONE of the following (A or B):
- A) Patient meets BOTH of the following (i and ii):
- i. Patient meets the standard Oncology – Braftovi Prior Authorization Policy criteria; AND
- ii. Patient meets ONE of the following (a or b):
- a) Patient has tried Tafinlar; OR
- b) Patient is currently receiving Braftovi;
- B) If the patient has met the standard Oncology – Braftovi PA Policy criteria, but has not met the exception criteria above (Aii), offer to review for the Preferred Product using the standard Oncology – Tafinlar PA Policy criteria.
Approval duration
1 year