Alecensa (alectinib) — United Healthcare

Initial criteria

• Diagnosis of anaplastic large cell lymphoma (ALCL)
• Used as initial palliative intent therapy or second-line and subsequent therapy
• Disease is one of the following: relapsed OR refractory
• Anaplastic lymphoma kinase (ALK)-positive

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Alecensa therapy

Approval duration

12 months