Cabometyx
Drug - Cabometyx® (cabozantinib) [Exelixis,Inc.]
January 2018
Therapeutic area - Oncology
Initial approval criteria
- Patient is 18 years of age or older AND
- Must have a diagnosis of advanced renal cell carcinoma (RCC) AND
- Must have received prior anti-angiogenic therapy AND
- Must not have recent history of hemorrhage not due to trauma AND
- Must be used as monotherapy AND
- Documentation of diagnosis from patient’s medical records must be provided at time of request
Renewal criteria
- Documentation must be supplied at time of request showing patient has no disease progression AND
- Must not have any one of the following:
- Hemorrhage not due to trauma
- Unmanaged gastrointestinal perforations or fistulas
- Palmar-plantar erythrodysesthesia syndrome Grade 2 or 3
- Uncontrolled severe hypertension
Approvals
Initial and renewal approval will be for 6 months
Quantity limits
34 tablets per 34 days
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411