alectinib (Alecensa®)

ORAL

Indications for Prior Authorization:

  • Non-small cell lung cancer, metastatic (anaplastic lymphoma kinase-positive): Treatment of anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung cancer (NSCLC) in patients who have progressed on or are intolerant to crizotinib

All of the following must be met as a condition for coverage:

  • Treatment of anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung cancer (NSCLC) in patients who have progressed on or are intolerant to crizotinib

This Medication is Not Approvable for the following condition(s):

  • Any condition not listed above as an approved indication

Dosing:

  • 600 mg twice daily; continue until disease progression or unacceptable toxicity.
Approval: 
 
One year
 

 

 

Last review date: July 25, 2016