Iressa — United Healthcare

Initial criteria

• Diagnosis of metastatic non-small cell lung cancer (NSCLC)
• Tumors are positive for epidermal growth factor receptor (EGFR) exon 19 deletions OR exon 21 (L858R) substitution mutations OR a known sensitizing EGFR mutation (e.g., exon 20 S768I, exon 18 G719X, exon 21 L861Q)

Reauthorization criteria

• Documentation of positive clinical response to Iressa therapy

Approval duration

12 months