Xalkori (crizotinib capsules and oral pellets) — Cigna
Histiocytic Neoplasm (ALK rearrangement/fusion-positive: Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease)
Initial criteria
- Patient age ≥ 18 years
- Patient has anaplastic lymphoma kinase (ALK) rearrangement/fusion-positive disease
- Patient has Langerhans cell histiocytosis OR Erdheim-Chester disease OR Rosai-Dorfman disease
Approval duration
1 year