Tagrisso (osimertinib tablets – AstraZeneca) — Cigna
Non-Small Cell Lung Cancer – Advanced or Metastatic Disease
Initial criteria
- Patient age ≥ 18 years
- Patient meets ONE of the following (i or ii):
- i. Patient has epidermal growth factor receptor (EGFR) mutation-positive disease as detected by an approved test
- Note: Examples of EGFR mutation-positive non-small cell lung cancer include the following: exon 19 deletion, exon 21 (L858R) substitution mutations, L861Q, G719X, and S768I
- ii. Patient meets BOTH of the following (a and b):
- a) Patient has epidermal growth factor receptor (EGFR) T790M mutation-positive disease as detected by an approved test
- b) Patient has progressed on treatment with at least one of the EGFR tyrosine kinase inhibitors (erlotinib, Iressa, Vizimpro, Gilotrif)
Approval duration
1 year