Afinitor
| Covered Uses: | All FDA approved indications not otherwise excluded from Part D. Additional off-label coverage is provided for advanced, estrogen-receptor positive breast cancer in postmenopausal women. |
| Exclusion Criteria: | Combination use with other tyrosine kinase inhibitors such as sorafenib or sunitinib. |
| Required Medical Information: | Coverage for RCC is provided after failure of treatment with sunitinib or sorafenib. Coverage for SEGA is provided for patients who are not candidates for curative surgical resection. For breast cancer coverage is provided if disease is refractory to letrozole or anastrozole and when used in combination with exemestane. |
| Age Restrictions: | |
| Prescriber Restrictions: | |
| Coverage Duration: | 12 months |
| Other Criteria: | |
| Excluded Drug Criteria: |
Last Modified on 12/19/2012