UnitedHealthcare
Afinitor (everolimus (antineoplastic))
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Breast Cancer: HR+ (HER2-), Thyroid Carcinoma:
    Duration: 12 Month(s)

    Hodgkin Lymphoma (HL), Kidney Cancer, Neuroendocrine Tumor (NET), Tuberous Sclerosis Complex:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Breast Cancer: HR+ (HER2-), Thyroid Carcinoma:
    Duration: 12 Month(s)

    Hodgkin Lymphoma (HL), Neuroendocrine Tumor (NET), Tuberous Sclerosis Complex:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    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: FDA Approved Indications
    Supporting Documentation Requirements: Histology
    ECOG Score Requirement Included in Policy: N/A
    Policy Includes Reference to Coverage for Non Clear Cell Histology: Yes
    If Non-Clear Cell Histology is Referenced in Policy is There a Trial and Failure Requirement: No

  • Step Therapy: Thyroid Carcinoma:
    ST Single Brand