everolimus — CareFirst (Caremark)

Initial criteria

• Requested medication is given as a single agent or in combination with lenvatinib as subsequent therapy for clear cell histology OR given as single-agent or in combination with lenvatinib or bevacizumab for non-clear cell histology

Reauthorization criteria

• Continuation may be approved when there is no evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months