Retevmo (selpercatinib capsules and tablets - Eli Lilly) — Cigna

Initial criteria

• Patient is age ≥ 2 years
• Patient has rearranged during transfection (RET) fusion-positive, RET mutation-positive disease, or RET pathogenic variant
• Patient meets ONE of the following (i or ii): i. Patient has anaplastic thyroid cancer; OR ii. Disease requires treatment with systemic therapy AND patient meets ONE of the following (a or b): a) Patient has medullary thyroid cancer; OR b) Disease is radioactive iodine-refractory

Approval duration

1 year