UnitedHealthcare
Cabometyx (cabozantinib)
Drugs for Cancer : Drugs for Cancer
  • Orally administered anticancer medication.
  • Hepatocellular Carcinoma:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Types: 2 of extensive tumor burden;For patients who received previous treatment with Nexavar/sorafenib;Hepatocellular Cancer;Metastatic disease;not a transplant candidate;not a transplant candidate and disease is unresectable
    ECOG Score Requirement Included in Policy: N/A

    Kidney Cancer:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: NCCN Guidelines
    ECOG Score Requirement Included in Policy: N/A
    Policy Includes Reference to Coverage for Non Clear Cell Histology: No
    If Non-Clear Cell Histology is Referenced in Policy is There a Trial and Failure Requirement: No

  • Prior Authorization: Hepatocellular Carcinoma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)

    Kidney Cancer:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes