Stivarga — Highmark
metastatic colorectal cancer
Initial criteria
- age ≥ 18 years
- for colorectal cancer: metastatic (ICD-10: C17, C18, C19, C78) and prior fluoropyrimidine-, oxaliplatin-, irinotecan-based chemotherapy, prior anti-VEGF therapy, and if RAS wild-type, prior anti-EGFR therapy
- for GIST: locally advanced, unresectable or metastatic (ICD-10: C49.A) with previous treatment with imatinib and sunitinib
- for hepatocellular carcinoma: (ICD-10: C22) with previous treatment with sorafenib
Reauthorization criteria
- prescriber attests member is tolerating therapy and has experienced a therapeutic response (disease improvement or delayed disease progression)
Approval duration
12 months