Vitrakvi (larotrectinib capsules and oral solution - Bayer) — Cigna
Pediatric diffuse high-grade gliomas with NTRK gene fusion-positive disease
Initial criteria
- Patient is age ≤ 21 years; AND
- The tumor is positive for neurotrophic receptor tyrosine kinase (NTRK) gene fusion; AND
- Patient meets ONE of the following (i or ii):
- i. The medication is used as adjuvant therapy; OR
- ii. The medication is used for recurrent or progressive disease.
Approval duration
1 year