Afinitor — CareFirst (Caremark)
Tuberous sclerosis complex (TSC) including SEGA, renal angiomyolipoma, or TSC-associated partial-onset seizures
Initial criteria
- Diagnosis of tuberous sclerosis complex
- Requested indication includes SEGA requiring therapeutic intervention, renal angiomyolipoma not requiring immediate surgery, or partial-onset seizures (for Afinitor Disperz)
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months