Alecensa (alectinib) — Highmark
adjuvant treatment of NSCLC following tumor resection (tumors ≥ 4 cm or node positive)
Initial criteria
- age ≥ 18 years
- Diagnosis of metastatic NSCLC (ICD-10: C34) OR Diagnosis of NSCLC (ICD-10: C34) with tumors ≥ 4 cm or node positive AND using Alecensa as adjuvant treatment following tumor resection
- Disease is ALK-positive as detected by an FDA-approved test
Reauthorization criteria
- Prescriber attests that member is tolerating therapy AND has experienced disease improvement OR delayed disease progression
Approval duration
12 months