Pemazyre (pemigatinib) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of unresectable locally advanced or metastatic cholangiocarcinoma (ICD-10: C22.1)
• disease harbors FGFR2 fusion or other rearrangement as detected by an FDA-approved test
• experienced therapeutic failure or intolerance to at least one prior 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