Hycamtin — CareFirst (Caremark)

Initial criteria

• Member has metastatic disseminated disease OR primary or recurrent regional disease and curative surgery and curative radiation therapy are not feasible.
• Member has contraindications to or disease that has progressed on anti-PD-L1 or anti-PD-1 monotherapy [e.g., Bavencio (avelumab), Keytruda (pembrolizumab)].
• Medication will be used as a single agent.

Reauthorization criteria

• Authorization may be granted when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months