Welireg — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient has a von Hippel-Lindau germline alteration as detected by genetic testing [Documentation required]; AND
• Patient has ONE of the following VHL-associated conditions: renal cell carcinoma, pancreatic neuroendocrine tumors, or central nervous system hemangioblastoma; AND
• Patient is not an eligible candidate for immediate surgery; AND
• Patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 [Documentation required]; AND
• Welireg is prescribed by or in consultation with an oncologist or a provider that specializes in the treatment of genetic disorders

Approval duration

1 year