Xermelo — CareFirst (Caremark)
carcinoid syndrome diarrhea
Initial criteria
- Member age ≥ 18 years
- Diagnosis of carcinoid syndrome diarrhea
- Member has had an inadequate response to somatostatin analog (SSA) therapy alone
- Requested medication will be used in combination with SSA therapy
Reauthorization criteria
- Member is using the requested medication for carcinoid syndrome diarrhea in combination with SSA therapy
- Member has achieved or maintained a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms (e.g., reduction in daily bowel movements)
Approval duration
12 months