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The Policy VaultThe Policy Vault

Cabometyx (cabozantinib)United Healthcare

Gastrointestinal Stromal Tumors (GIST)

Preferred products

  • Gleevec (imatinib)
  • Sutent (sunitinib)
  • Stivarga (regorafenib)
  • Qinlock (ripretinib)

Initial criteria

  • Diagnosis of GIST
  • Patient has one of the following: gross residual disease (R2 resection) OR unresectable primary disease OR tumor rupture OR recurrent/metastatic disease
  • Disease has progressed on all of the following: Gleevec (imatinib); Sutent (sunitinib); Stivarga (regorafenib); standard dose Qinlock (ripretinib)

Reauthorization criteria

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

Approval duration

12 months