Tagrisso™

Drug - Tagrisso™ (osimertinib) [AstraZeneca Pharmaceuticals LP]

May 2016

Therapeutic Area - Oncology

Approval criteria

• Patient must be 18 years of age or older AND
• Must have a diagnosis of metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive non-small cell lung cancer (NSCLC), as detected by an FDA-approved test (copy of test results must be submitted at time of request) AND
• Have had disease progression on or after EGFR TKI therapy

Quantity limit

• Maximum of 34 tablets per 34 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411