Temodar — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of Ewing sarcoma as second-line therapy in combination with irinotecan with or without vincristine for relapsed, progressive or metastatic disease.

Reauthorization criteria

• Authorization may be renewed if there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

Approval duration

12 months