Pemazyre (pemigatinib) — United Healthcare

Initial criteria

• Diagnosis of cholangiocarcinoma
• AND Disease is one of the following: unresectable locally advanced OR resected gross residual (R2) OR metastatic
• AND Disease has presence of a fibroblast growth factor receptor 2 (FGFR2) fusion or other rearrangement
• AND Patient has been previously treated

Reauthorization criteria

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

Approval duration

12 months