Zelboraf (vemurafenib) — United Healthcare
Central Nervous System (CNS) cancers
Preferred products
- Cotellic (cobimetinib)
Initial criteria
- EITHER (Patient has metastatic brain lesions AND Zelboraf is active against primary tumor [melanoma]) OR (Diagnosis of glioma AND (Incomplete resection, biopsy, or surgically inaccessible location OR Disease is recurrent or progressive))
- Cancer is positive for BRAF V600E mutation
- Used in combination with Cotellic (cobimetinib)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Zelboraf therapy
Approval duration
12 months