Lenvima Sgm 1865 A P2024_R
Defines prior authorization coverage criteria, indications (FDA and compendial), documentation requirements, authorization durations, and continuation criteria for lenvatinib across multiple oncologic indications.
No material clinical/coverage changes
Coverage Summary
Coverage stance: covered_with_criteria. This policy lists covered FDA-approved indications and compendial uses for lenvatinib and requires prior authorization. Documentation, including laboratory confirmation of MMR tumor status where applicable, must be submitted for review. Continuation of therapy may be authorized only when there is no evidence of unacceptable toxicity and no evidence of disease progression while on the current regimen.
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