Retevmo (selpercatinib) — Highmark
advanced or metastatic medullary thyroid cancer (MTC) with RET mutation requiring systemic therapy
Initial criteria
- age ≥ 2 years
- diagnosis of thyroid cancer (ICD-10: C73) classified as medullary thyroid cancer
- disease is advanced or metastatic
- disease harbors a RET mutation as detected by an FDA approved test
Reauthorization criteria
- prescriber attests that member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months