Lenvima — Highmark
differentiated thyroid cancer
Initial criteria
- age ≥ 18 years
- for thyroid cancer: locally recurrent or metastatic, progressive, radioactive-iodine refractory (ICD-10: C73)
- for renal cell carcinoma: advanced RCC (ICD-10: C64) AND either (in combination with pembrolizumab as first-line) OR (with everolimus after one prior anti-angiogenic therapy failure)
- for hepatocellular carcinoma: unresectable (ICD-10: C22) and using as first-line treatment
- for endometrial carcinoma: advanced (ICD-10: C54, C55) using in combination with pembrolizumab, MSI-H negative or pMMR by FDA-approved test, disease progression after prior systemic therapy, and not a candidate for curative surgery or radiation
Reauthorization criteria
- prescriber attests member is tolerating therapy and has experienced a therapeutic response (disease improvement or delayed disease progression)
Approval duration
12 months