Koselugo (selumetinib) — United Healthcare
Neurofibromatosis type 1 with inoperable plexiform neurofibromas causing significant morbidity
Initial criteria
- Diagnosis of neurofibromatosis type 1
- Patient has plexiform neurofibromas that are both of the following:
- a. Inoperable
- b. Causing significant morbidity (e.g., disfigurement, motor dysfunction, pain, airway dysfunction, visual impairment, bladder/bowel dysfunction)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Koselugo therapy
Approval duration
12 months