leuprolide acetate injection solution — CareFirst (Caremark)
Recurrent, unresectable or metastatic salivary gland tumors that are androgen receptor positive
Initial criteria
- Tumor is androgen receptor positive
- Used as a single agent for recurrent, unresectable, or metastatic salivary gland tumors
Reauthorization criteria
- Member is experiencing clinical benefit to therapy
- Member has not experienced an unacceptable toxicity
Approval duration
12 months