Zelboraf (vemurafenib) — United Healthcare

Initial criteria

• Diagnosis of follicular carcinoma OR oncocytic carcinoma OR papillary carcinoma
• Disease is unresectable locoregional recurrent OR metastatic OR persistent
• Patient has symptomatic disease OR progressive disease
• Disease is refractory to radioactive iodine
• Cancer is positive for BRAF V600 mutation

Reauthorization criteria

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

Approval duration

12 months