Tarceva (erlotinib) — United Healthcare

Initial criteria

• Diagnosis of non-small cell lung cancer (NSCLC)
• Disease is recurrent OR advanced OR metastatic
• Tumors are positive for one of the following: EGFR exon 19 deletions OR exon 21 (L858R) substitution mutations OR a known sensitizing EGFR mutation (e.g., S768I, L861Q, G719X)

Reauthorization criteria

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

Approval duration

12 months