Xermelo (telotristat ethyl) — Highmark
carcinoid syndrome diarrhea
Initial criteria
- age ≥ 18 years
- Diagnosis of carcinoid syndrome (ICD-10: E34.0) diarrhea
- Use in combination with a somatostatin analog
- Inadequate control on somatostatin analog monotherapy
Reauthorization criteria
- Reduction in average number of daily bowel movements
- Continued use in combination with a somatostatin analog
Approval duration
Initial: up to 3 months (12 months for Delaware Commercial fully-insured and ACA members); Reauthorization: up to 12 months