Turalio (pexidartinib) — United Healthcare
Pigmented villonodular synovitis (PVNS)
Initial criteria
- Patient is less than 19 years of age OR
- Diagnosis of tenosynovial giant cell tumor (TGCT) / pigmented villonodular synovitis (PVNS) OR
- Diagnosis of one of the following: Langerhans Cell Histiocytosis, Erdheim-Chester Disease, Rosai-Dorfman Disease AND Colony stimulating factor 1 receptor (CSF1R) mutation positive OR
- Drug is recognized for treatment of the cancer indication by the National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium with a Category of Evidence and Consensus of 1, 2A, or 2B
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Turalio therapy
Approval duration
12 months