Zelboraf

Covered Uses:	All FDA-approved indications not otherwise excluded from Part D. Additional coverage for off-label use includes unresectable or metastatic melanoma in patients with BRAFv600K mutation
Exclusion Criteria:	Combination use with ipilimumab
Required Medical Information:	For unresectable or metastatic melanoma with BRAFV600E or BRAFV600K mutation as detected by FDA approved or CLIA lab approved reliable assay
Age Restrictions:
Prescriber Restrictions:
Coverage Duration:	12 months
Other Criteria:

Last Modified on 12/20/2012