vismodegib — CareFirst (Caremark)

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