Alecensa (alectinib) — United Healthcare
Non-Small Cell Lung Cancer (NSCLC)
Initial criteria
- Diagnosis of non-small cell lung cancer (NSCLC)
- Disease is anaplastic lymphoma kinase (ALK)-positive
- One of the following: Disease is recurrent OR advanced OR metastatic OR used as adjuvant treatment following tumor resection
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Alecensa therapy
Approval duration
12 months