Rozlytrek (entrectinib) — Highmark

NTRK gene fusion–positive solid tumors

Initial criteria

For metastatic NSCLC: age ≥ 18 years AND diagnosis of metastatic NSCLC (ICD-10: C34) AND tumor ROS1-positive as detected by an FDA-approved test
For solid tumors: age > 1 month AND tumor has NTRK gene fusion as detected by an FDA-approved test without known acquired resistance mutation AND (tumors are metastatic OR surgical resection likely to result in severe morbidity) AND (no satisfactory alternative treatments OR tumors have progressed following treatment)

Prescriber attests that member is tolerating therapy AND has experienced disease improvement OR delayed disease progression

up to 2 years