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Testim — CareFirst (Caremark)

Metastatic mammary cancer in females

Initial criteria

  • Patient is male (unless request is for metastatic mammary cancer use).
  • Drug is being prescribed for an FDA-approved or compendial indication.
  • For breast cancer (hormone-responsive tumor): patient is premenopausal with breast cancer who has benefited from oophorectomy AND is considered to have a hormone-responsive tumor.
  • Requested drug is NOT being prescribed for age-related (late-onset) hypogonadism.