Alecensa (alectinib) — United Healthcare
Central Nervous System (CNS) Cancers / Pediatric Diffuse High-Grade Glioma
Initial criteria
- One of the following: diagnosis of metastatic brain cancer from NSCLC OR diagnosis of pediatric diffuse high-grade glioma
- Tumor is anaplastic lymphoma kinase (ALK)-positive
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Alecensa therapy
Approval duration
12 months