CurrentUnitedHealthcarePolicy N/A

Ayvakit (avapritinib) prior authorization policy

Prior authorization/notification criteria for coverage of Ayvakit (avapritinib) across indications including gastrointestinal stromal tumor (GIST), myeloid/lymphoid neoplasms with eosinophilia and FIP1L1-PDGFRA rearrangement, and systemic mastocytosis (advanced and indolent). Applies to UnitedHealthcare pharmacy programs; members under 19 auto-process without review.

Policy Summary

PayerUnitedHealthcare

PolicyAyvakit (avapritinib) prior authorization policy

Policy CodePolicy N/A

Change TypeAnnual review (wording/reference updates; no material change)

Effective DateOct 1, 2025

Next Review Date

Key ActionSubmit prior authorization with documentation of diagnosis and relevant molecular testing; approvals issued for 12 months (members <19 auto-process).

POLICY UPDATE CHANGES

Annual review updated list of examples of therapies approved for GIST without change to clinical intent; updated references.

4Covered Indications (major categories: GIST, Myeloid/Lymphoid neoplasms, Advanced SM, Indolent SM)

12 monthsStandard authorization duration

>=50 x10^9/LPlatelet threshold for systemic mastocytosis

Auto-processMembers <19 years

Coverage stance: Ayvakit (avapritinib) is covered with criteria under prior authorization/notification. Scope: criteria apply to UnitedHealthcare pharmacy programs and include GIST, myeloid/lymphoid neoplasms with eosinophilia (FIP1L1-PDGFRA), and systemic mastocytosis (advanced and indolent); members 19 years of age auto-process without a coverage review. Authorization duration is 12 months when criteria are met. Evidence recognition: the policy states the drug is recognized by the NCCN and Biologics Compendium for specified indications, which supports coverage when the listed criteria are satisfied.

OpenPayer

Ayvakit (avapritinib) prior authorization policy

Coverage Summary