Valchlor (mechlorethamine) — United Healthcare
Histiocytic Neoplasms (Langerhans Cell Histiocytosis)
Initial criteria
- Diagnosis of Langerhans Cell Histiocytosis (LCH)
- AND Skin disease is unifocal and isolated
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Valchlor
Approval duration
12 months