COVERED USES:

FDA Approved Indications:

Treatment of advanced renal cell carcinoma after treatment failure with sunitinib or sorafenib.

All FDA-approved indications not otherwise excluded from Part D.

AGE RESTRICTIONS:

NA

PRESCRIBER RESTRICTIONS:

Must be prescribed by an oncologist.

REQUIRED MEDICAL INFORMATION:

For initiation of treatment, a prior authorization form and relevant chart notes documenting medical rationale are required and for continuation of therapy, ongoing documentation of successful response to the medication may be necessary.

CRITERIA:

Patient must have a diagnosis of advanced renal cell carcinoma and have had disease progression on sunitinib, sorafenib or both.

EXCLUSION CRITERIA:

NA

COVERAGE DURATION:

Initial prior authorization and reauthorization will be approved for up to six months.