Vitrakvi (larotrectinib) — Highmark

Initial criteria

• Tumor has NTRK gene fusion without known acquired resistance mutation, detected by an FDA-approved test AND (tumors are metastatic OR surgical resection likely to result in severe morbidity) AND (no satisfactory alternative treatments OR tumors have progressed following treatment)

Reauthorization criteria

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

Approval duration

up to 2 years