Coverage is subject to the specific terms of the member’s benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the www.fepblue.org website.
Necitumumab (Portrazza) may be considered medically necessary in combination with gemcitabine and cisplatin as first-line treatment of individuals 18 years of age or older with metastatic squamous non-small cell lung cancer (NSCLC).
Necitumumab (Portrazza) is considered experimental/investigational for any other indication and therefore, non-covered. Scientific evidence does not support its use for any other indications.