Sutent — Highmark
renal cell carcinoma
Preferred products
- sunitinib (generic)
Initial criteria
- age ≥ 18 years
- for GIST: (ICD-10: C49.A) and prior therapeutic failure, intolerance or contraindication to imatinib
- for pNET: progressive, well-differentiated pNET (ICD-10: C25.4) locally advanced or metastatic
- for RCC: advanced RCC (ICD-10: C64) OR post-nephrectomy adjuvant use at high risk of recurrence
- if brand Sutent requested: therapeutic failure or intolerance to generic sunitinib
Reauthorization criteria
- prescriber attests member is tolerating therapy and has experienced a therapeutic response (disease improvement or delayed disease progression)
- for brand Sutent: experienced therapeutic failure or intolerance to generic sunitinib
Approval duration
12 months