Iclusig (ponatinib tablets) — Cigna
Gastrointestinal Stromal Tumor (GIST)
Initial criteria
- Approve for 1 year if the patient meets BOTH of the following (A and B):
- A) Patient is age ≥ 18 years; AND
- B) Patient has tried each of the following (i, ii, iii, and iv):
- i. One of imatinib or Ayvakit (avapritinib tablets); AND
- ii. One of sunitinib or dasatinib; AND
- iii. Stivarga (regorafenib tablets); AND
- iv. Qinlock (ripretinib tablets).
Approval duration
1 year