Votrient — Highmark
advanced renal cell carcinoma
Preferred products
- pazopanib (generic)
Initial criteria
- age ≥ 18 years
- for RCC: advanced RCC (ICD-10: C64)
- for soft tissue sarcoma: advanced disease (ICD-10: C49.9) excluding adipocytic sarcoma and GIST, with failure of at least one prior chemotherapy regimen
- if brand Votrient requested: therapeutic failure or intolerance to generic pazopanib
Reauthorization criteria
- prescriber attests member is tolerating therapy and has experienced a therapeutic response (disease improvement or delayed disease progression)
- for brand Votrient: experienced therapeutic failure or intolerance to generic pazopanib
Approval duration
12 months