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The Policy VaultThe Policy Vault

Retevmo (selpercatinib)United Healthcare

non-small cell lung cancer (NSCLC)

Initial criteria

  • Diagnosis of non-small cell lung cancer (NSCLC)
  • Disease is one of the following: recurrent OR advanced OR metastatic
  • Presence of RET gene fusion-positive or RET rearrangement positive tumors

Reauthorization criteria

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

Approval duration

12 months