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Cotellic — CareFirst (Caremark)

Histiocytic neoplasms (Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease)

Initial criteria

  • Used as a single agent for treatment of histiocytic neoplasms (Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease)

Reauthorization criteria

  • No evidence of unacceptable toxicity or disease progression while on current regimen

Approval duration

12 months