Xermelo (telotristat ethyl) — United Healthcare
Carcinoid syndrome diarrhea
Preferred products
- octreotide
- Sandostatin LAR
- Somatuline Depot
- Lanreotide
Initial criteria
- Diagnosis of carcinoid syndrome diarrhea
- Diarrhea is inadequately controlled with somatostatin analog therapy (e.g., octreotide, Sandostatin LAR, Somatuline Depot, Lanreotide)
- Used in combination with somatostatin analog therapy (e.g., octreotide, Sandostatin LAR, Somatuline Depot, Lanreotide)
Reauthorization criteria
- Documentation of positive clinical response to Xermelo
Approval duration
12 months