VIZIMPRO (dacomitinib)
SELF ADMINISTRATION
Indications for Prior Authorization:
- Indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 L858R substitution mutations as detected by an FDA-approved test
Patients must meet the following criteria for the indication(s) above:
- Patient has a diagnosis of metastatic NSCLC, AND
- Patient has EGFR exon 19 deletion or exon 21 L858R substitution mutation as detected by an FDA-approved test, AND
- Prescribed by an oncologist, AND
- Vizimpro® will not be used in combination with proton pump inhibitors (PPIs)
Dosing:
- 45mg once daily
Approval:
- 1 year
Last review date: September 3, 2019