Krazati (adagrasib) — Highmark
locally advanced or metastatic non-small cell lung cancer (NSCLC)
Initial criteria
- age ≥ 18 years
- diagnosis of locally advanced or metastatic NSCLC (ICD-10: C34)
- disease is KRAS G12C-mutated as determined by an FDA-approved test
- Krazati is used as a single agent
- member has received at least one prior systemic therapy
Reauthorization criteria
- prescriber attests that the member is tolerating therapy and has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months