vismodegib — CareFirst (Caremark)
diffuse basal cell carcinoma (e.g., Gorlin syndrome)
Initial criteria
- Authorization may be granted for treatment of advanced, diffuse (e.g., Gorlin syndrome), recurrent, nodal, or metastatic basal cell carcinoma, as a single agent.
Reauthorization criteria
- Authorization may be granted for continued treatment when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Approval duration
12 months