Tagrisso (osimertinib) — Highmark

Initial criteria

• Adjuvant setting: age ≥ 18 years AND diagnosis of NSCLC (ICD‑10: C34) AND adjuvant therapy after tumor resection AND disease harbors EGFR exon 19 deletions OR exon 21 L858R mutations (FDA‑approved test)
• Locally advanced unresectable: age ≥ 18 years AND diagnosis of Stage III NSCLC (ICD‑10: C34) AND disease has not progressed after concurrent or sequential platinum‑based chemoradiation AND disease harbors EGFR exon 19 deletions OR exon 21 L858R mutations
• First‑line metastatic: age ≥ 18 years AND diagnosis of metastatic NSCLC (ICD‑10: C34) AND first‑line use AND disease harbors EGFR exon 19 deletions OR exon 21 L858R mutations
• Combination first‑line locally advanced/metastatic: age ≥ 18 years AND diagnosis of locally advanced or metastatic NSCLC (ICD‑10: C34) AND first‑line use AND Tagrisso in combination with pemetrexed and platinum‑based chemotherapy AND disease harbors EGFR exon 19 deletions OR exon 21 L858R mutations
• Metastatic EGFR T790M mutation‑positive NSCLC: age ≥ 18 years AND diagnosis of metastatic NSCLC (ICD‑10: C34) AND disease harbors EGFR T790M mutation (FDA‑approved test) AND progression on or after EGFR tyrosine kinase inhibitor therapy (e.g., erlotinib, gefitinib)