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Gilotrif (afatinib) — United Healthcare

Brain metastases due to EGFR-sensitizing mutation positive non-small cell lung cancer

Initial criteria

  • Diagnosis of brain metastasis due to EGFR-sensitizing mutation positive non-small cell lung cancer

Reauthorization criteria

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

Approval duration

12 months