Fotivda (tivozanib) — CareFirst (Caremark)
Relapsed or refractory advanced renal cell carcinoma (RCC) following two or more prior systemic therapies
Initial criteria
- Diagnosis of renal cell carcinoma of clear cell histology
- Disease is relapsed, refractory, advanced, or stage IV
- Member has received at least two prior systemic therapies
- Requested medication will be used as a single agent
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months