Cotellic (cobimetinib tablets – Genentech/Roche) — Cigna

Central Nervous System Cancer

Initial criteria

Patient age ≥ 18 years
Medication is being used for ONE of the following: Adjuvant treatment of pilocytic astrocytoma OR pleomorphic xanthoastrocytoma OR circumscribed ganglioglioma/neuroglioma/glioneuronal tumor OR Recurrent or progressive high-grade glioma OR circumscribed glioma OR glioblastoma OR Brain metastases due to melanoma
Patient has BRAF V600 mutation-positive disease
Medication is prescribed in combination with Zelboraf (vemurafenib tablets)

1 year