Fruzaqla — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of metastatic colorectal cancer (ICD-10: C17, C18, C19, C78)
• member has received previous treatment with a fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy
• member has received previous treatment with an anti-VEGF therapy
• If RAS wild-type: has received prior anti-EGFR therapy OR prescriber attests anti-EGFR therapy would not be medically appropriate

Reauthorization criteria

• prescriber attests member is tolerating therapy and has experienced a therapeutic response (disease improvement or delayed disease progression)

Approval duration

12 months