Gavreto (pralsetinib) — United Healthcare

Initial criteria

• EITHER: All of the following:
• Diagnosis of one of the following: follicular carcinoma OR oncocytic carcinoma OR papillary carcinoma
• Disease is one of the following: unresectable locoregional recurrent disease OR persistent disease OR metastatic disease
• Disease is RET gene-fusion positive
• Disease is not amenable to radioactive iodine therapy
• OR All of the following:
• Diagnosis of medullary carcinoma
• Disease is recurrent, persistent, or progressive OR symptomatic with distant metastases
• Disease is RET-mutation positive
• OR All of the following:
• Diagnosis of anaplastic carcinoma
• Disease is stage IVA or IVB (locoregional) OR metastatic
• Disease is RET gene fusion positive

Reauthorization criteria

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

Approval duration

12 months