Covered Uses: | All FDA approved indications not otherwise excluded from Part D. Additional coverage for off-label use is provided for metastatic thyroid cancer. |
Exclusion Criteria: | Combination use with other kinase inhibitors (for example, sorafenib, etc). |
Required Medical Information: | Coverage is provided for Gastrointestinal stromal tumor when the patient had evidence of disease progression or experienced intolerance while receiving imatinib mesylate (Gleevec). |
Age Restrictions: | |
Prescriber Restrictions: | |
Coverage Duration: | 12 months |
Other Criteria: |