Zejula — CareFirst (Caremark)
Uterine leiomyosarcoma (uLMS)
Initial criteria
- Member has BRCA2-altered uterine leiomyosarcoma
- Requested medication will be used as a single agent for advanced, recurrent, metastatic, or inoperable disease
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on the current regimen
Approval duration
12 months