Inlyta — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for treatment of thymic carcinoma when both of the following criteria are met:
• • The requested medication will be used as subsequent therapy or in members who cannot tolerate first-line combination regimens.
• • The requested medication will be used in combination with avelumab.

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