Iclusig (ponatinib) — United Healthcare
Gastrointestinal Stromal Tumor (GIST)
Preferred products
- imatinib
- sunitinib
- regorafenib
- ripretinib (standard dose)
Initial criteria
- Diagnosis of gastrointestinal stromal tumor (GIST)
- AND disease is one of the following:
- gross residual disease (R2 resection)
- unresectable primary disease
- tumor rupture
- recurrent/metastatic disease after progression on approved therapies (e.g., imatinib, sunitinib, regorafenib, and standard dose ripretinib)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Iclusig therapy
Approval duration
12 months