WHA

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

  • Guideline ID
    GL-148174

  • Formulary
    premium

  • Effective date
    Aug 1, 2024

  • P&T approval date
    Jun 28, 2017

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

  1. Alunbrig Prescribing Information. Takeda Pharmaceuticals America, Inc. Lexington, MA. August 2023.
  2. 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.
  • 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.