phenoxybenzamine — CareFirst (Caremark)
paraganglioma
Preferred products
- doxazosin
- prazosin
- terazosin
Initial criteria
- Authorization may be granted when the requested drug is being prescribed for the treatment of pheochromocytoma or paraganglioma to control episodes of hypertension and sweating when ONE of the following criteria are met:
- The patient has experienced an inadequate treatment response to an alpha 1 selective adrenergic receptor blocker (e.g., doxazosin, prazosin, terazosin)
- OR the patient has experienced an intolerance to an alpha 1 selective adrenergic receptor blocker (e.g., doxazosin, prazosin, terazosin)
- OR the patient has a contraindication that would prohibit a trial of an alpha 1 selective adrenergic receptor blocker (e.g., doxazosin, prazosin, terazosin)
Approval duration
12 months