erlotinib — CareFirst (Caremark)
Renal cell carcinoma (RCC)
Initial criteria
- Member has relapsed or stage IV advanced papillary renal cell carcinoma including hereditary leiomyomatosis and renal cell carcinoma (HLRCC)
- Disease has non-clear cell histology
- Erlotinib is used in combination with bevacizumab
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months