Retevmo (selpercatinib) — United Healthcare

Initial criteria

• Option 1 (MTC): Diagnosis of medullary thyroid cancer (MTC) AND Disease is advanced OR metastatic AND Disease has presence of RET gene mutation AND Disease requires treatment with systemic therapy
• Option 2 (thyroid cancer): Diagnosis of thyroid cancer AND Disease is advanced OR metastatic AND Disease is RET gene fusion-positive AND Disease requires treatment with systemic therapy AND Patient is radioactive iodine-refractory OR Treatment with radioactive iodine is not appropriate

Reauthorization criteria

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

Approval duration

12 months