Caprelsa (vandetanib) — United Healthcare

Initial criteria

• Diagnosis of ONE of the following: Follicular carcinoma OR Oncocytic carcinoma OR Papillary carcinoma
• ONE of the following: Unresectable recurrent disease OR Persistent locoregional disease OR Metastatic disease
• ONE of the following: Patient has symptomatic disease OR Patient has progressive disease
• Disease is refractory to radioactive iodine treatment

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Caprelsa therapy

Approval duration

12 months