Xalkori (crizotinib) — United Healthcare
Histiocytic Neoplasms
Initial criteria
- Diagnosis of one of the following: Langerhans Cell Histiocytosis OR Erdheim-Chester Disease OR Rosai-Dorfman Disease
- Disease is positive for ALK rearrangement
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Xalkori therapy
Approval duration
12 months