Caprelsa (vandetanib) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of medullary thyroid cancer (ICD-10: C73)
• disease is unresectable locally advanced or metastatic
• disease is symptomatic or progressive

Reauthorization criteria

• prescriber attests member is tolerating therapy
• member has experienced therapeutic response defined as either disease improvement OR delayed disease progression

Approval duration

12 months