Demser — Medica

Initial criteria

• Patient has diagnosis of pheochromocytoma
• Patient has tried a selective alpha blocker (e.g., doxazosin, terazosin, or prazosin)
• Patient has tried phenoxybenzamine (brand or generic)
• Medication is prescribed by or in consultation with an endocrinologist or a physician who specializes in the management of pheochromocytoma

Reauthorization criteria

• Patient is currently receiving metyrosine AND medication is prescribed by or in consultation with an endocrinologist or a physician who specializes in the management of pheochromocytoma

Approval duration

1 year