Inlyta — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for treatment of progressive and/or symptomatic papillary, oncocytic (Hürthle cell), or follicular thyroid carcinoma that is not amenable to radioactive iodine (RAI) therapy.

Reauthorization criteria

• Authorization of 12 months may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months