Balversa (erdafitinib) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of locally advanced or metastatic urothelial carcinoma (ICD-10: C67, C68)
• presence of susceptible FGFR3 genetic alteration as detected by an FDA-approved test
• disease progression on or after at least one prior line of systemic therapy
• if the member has not received prior PD-1 or PD-L1 inhibitor therapy, prescriber attests member is not eligible for such therapy

Reauthorization criteria

• prescriber attests member is tolerating therapy
• member has experienced a therapeutic response defined as disease improvement OR delayed disease progression

Approval duration

12 months