Lorbrena (lorlatinib) — United Healthcare
non-small cell lung cancer (NSCLC)
Preferred products
- Augtyro (repotrectinib)
- Rozlytrek (entrectinib)
- Xalkori (crizotinib)
- Zykadia (ceritinib)
Initial criteria
- Diagnosis of NSCLC
- AND one of the following:
- Disease is recurrent, advanced, or metastatic AND anaplastic lymphoma kinase (ALK)-positive
- OR Disease is advanced, metastatic, or recurrent AND ROS proto-oncogene 1 (ROS1)-positive AND Disease has progressed on at least one of the following therapies: Augtyro (repotrectinib) OR Rozlytrek (entrectinib) OR Xalkori (crizotinib) OR Zykadia (ceritinib)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Lorbrena therapy
Approval duration
12 months