Thalomid (thalidomide) — United Healthcare

Initial criteria

• One of the following:
• Diagnosis of HIV-negative Kaposi Sarcoma
• OR
• Both of the following:
• Diagnosis of AIDS-related Kaposi Sarcoma
• AND
• Patient is currently being treated with antiretroviral therapy (ART)
• AND
• Not used as first line therapy
• AND
• Patient has immune reconstitution inflammatory syndrome (IRIS)

Reauthorization criteria

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

Approval duration

12 months