Thalomid (thalidomide) — United Healthcare

Initial criteria

• Diagnosis of moderate to severe erythema nodosum leprosum (ENL)
• AND
• One of the following:
• Used for acute treatment
• OR
• Used as maintenance therapy for prevention and suppression of cutaneous manifestations of ENL recurrence

Reauthorization criteria

• Documentation of positive clinical response to Thalomid therapy

Approval duration

12 months