Xalkori (crizotinib) — United Healthcare

Initial criteria

• Diagnosis of metastatic or unresectable cutaneous melanoma
• Disease is ROS1 gene fusion-positive
• Used as second-line or subsequent therapy for disease progression, intolerance, and/or projected risk of progression with BRAF-targeted therapy

Reauthorization criteria

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

Approval duration

12 months