temozolomide generic — Cigna

Initial criteria

• Patient has ONE of the following: carcinoid tumors or neuroendocrine tumor of GI tract, lung or thymus; islet cell tumors or pancreatic neuroendocrine tumors; extrapulmonary poorly differentiated neuroendocrine carcinoma; large or small cell carcinoma; mixed neuroendocrine‑non‑neuroendocrine neoplasm; well differentiated grade 3 neuroendocrine tumor

Approval duration

1 year