Lenvima (lenvatinib) — CareFirst (Caremark)

Initial criteria

• Requested drug will be used in combination with everolimus (Afinitor) and either of the following is met: disease histology is predominantly clear cell and the member has used prior therapy OR the disease histology is non-clear cell
• OR Requested drug will be used in combination with pembrolizumab (Keytruda)

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months