Alunbrig (brigatinib)
Indications for Prior Authorization
Alunbrig (brigatinib)
-
For diagnosis of Non-small cell lung cancer (NSCLC)
Indicated for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) as detected by an FDA-approved test.
Criteria
Alunbrig
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
- Diagnosis of non-small cell lung cancer (NSCLC)
Alunbrig
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
- Patient does not show evidence of progressive disease while on therapy
P & T Revisions
2024-06-05, 2023-08-21, 2023-06-08, 2022-04-28, 2021-06-03, 2021-04-07, 2020-06-30, 2020-06-04
References
- Alunbrig Prescribing Information. Takeda Pharmaceuticals America, Inc. Lexington, MA. August 2023.
- National Comprehensive Cancer Network (NCCN) Non-small cell lung cancer guideline. v.3.2022. Available at: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed April 28, 2022.
Revision History
- 2024-06-05: 2024 Annual Review - No criteria changes
- 2023-08-21: Removed prescriber requirement
- 2023-06-08: Program update to remove "Patient has anaplastic lymphoma kinase (ALK)-positive disease as detected with an FDA-approved test or test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)*" criterion and to remove "Disease is metastatic" criterion.
- 2022-04-28: Annual review - No changes to criteria, background updates
- 2021-06-03: Annual review: Background updates.
- 2021-04-07: Updated GPIs
- 2020-06-30: Removed embedded step and note.
- 2020-06-04: Annual review: Updated initial and reauthorization criteria, notes, and background.
HEALTHY LIVING