Vandetanib (Caprelsa)
Defines medical necessity criteria, approvals, dosing limits, and documentation requirements for vandetanib (Caprelsa) for commercial, HIM, and Medicaid lines of business including initial and continuation criteria for medullary and differentiated thyroid carcinoma and programmatic billing/authorization notes.
1Q 2026 annual review: for DTC, added disease qualifiers of progressive and/or symptomatic, removed requirement for radioactive iodine therapy for oncocytic carcinoma, and revised status from 'not amenable' to 'refractory' per NCCN; added request does not exceed health plan-approved quantity limit; extended initial approval duration for Medicaid/HIM from 6 to 12 months.
Revised approval duration for Commercial line of business to 12 months or duration of request, whichever is less.
Clarified DTC be recurrent, advanced, or metastatic per NCCN; added persistent disease as a covered tumor type in 1Q2023.
Clarified generic redirection language to 'must use' for oral oncology agents.
References and nomenclature updated (e.g., 'Hurthle cell' to 'oncocytic carcinoma') and routine reference updates in annual reviews 2022-2025.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.