Erivedge (vismodegib capsules - Genentech/Roche) — Cigna

Initial criteria

• Patient is age ≥ 18 years
• EITHER (a) patient has recurrent basal cell carcinoma following surgery or radiation therapy OR (b) patient is not a candidate for surgery AND according to the prescriber, the patient is not a candidate for radiation therapy

Reauthorization criteria

• Patient is currently receiving Erivedge

Approval duration

1 year