Retevmo (selpercatinib) — Highmark
advanced or metastatic RET fusion-positive thyroid cancer requiring systemic therapy and radioactive iodine-refractory if appropriate
Initial criteria
- age ≥ 2 years
- diagnosis of thyroid cancer (ICD-10: C73)
- disease is advanced or metastatic
- disease harbors a RET gene fusion as detected by an FDA approved test
- if radioactive iodine is appropriate, member is radioactive iodine-refractory
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