Retevmo (selpercatinib) — United Healthcare

Initial criteria

• Diagnosis of one of the following histiocytic neoplasms: Langerhans Cell Histiocytosis OR Erdheim-Chester disease OR Rosai-Dorfman disease
• Used for RET fusion target as a single agent

Reauthorization criteria

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

Approval duration

12 months