Erivedge (vismodegib) — United Healthcare

Initial criteria

• Diagnosis of metastatic basal cell carcinoma OR (Diagnosis of locally advanced basal cell carcinoma AND one of the following: cancer has recurred following surgery OR patient is not a candidate for surgery OR patient is not a candidate for radiation)

Reauthorization criteria

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

Approval duration

12 months