Exkivity (mobocertinib capsules - Takeda) — Cigna

Initial criteria

• Patient is currently receiving Exkivity; AND
• Patient age ≥ 18 years; AND
• Patient has locally advanced or metastatic disease; AND
• Patient has epidermal growth factor receptor (EGFR) exon 20 insertion-positive disease; AND
• The mutation was determined by an approved test; AND
• Patient has previously tried at least one platinum-based chemotherapy (e.g., carboplatin, cisplatin, oxaliplatin)

Approval duration

1 year