Retevmo (selpercatinib) — Highmark
locally advanced or metastatic RET fusion-positive non-small cell lung cancer (NSCLC)
Initial criteria
- age ≥ 18 years
- diagnosis of NSCLC (ICD-10: C34)
- disease is locally advanced or metastatic
- disease harbors a RET gene fusion 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