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Lonsurf (trifluridine and tipiracil tablets) — Cigna

Colon, Rectal, or Appendiceal Cancer (metastatic)

Initial criteria

  • Patient has been previously treated with a fluoropyrimidine; AND
  • Patient has been previously treated with oxaliplatin; AND
  • Patient has been previously treated with irinotecan; AND
  • If the patient’s tumor or metastases are wild-type RAS (KRAS wild-type and NRAS wild-type), Erbitux (cetuximab) or Vectibix (panitumumab) has been tried

Approval duration

1 year