CP.PHAR.204 Trabectedin
CP.PHAR.204 Trabectedin (Yondelis) - Health Net
Clinical Policy: Trabectedin (Yondelis). Reference Number: CP.PHAR.204. Effective Date: 05.01.16. Last Review Date: 02.24. Line of Business: HIM, Medicaid.
Clinical Policy: Trabectedin (Yondelis) - NH Healthy Families
Reference Number: CP.PHAR.204. Effective Date: 05/16. Coding Implications. Last ... Yondelis is an alkylating drug/intravenous formulation indicated for:.
Page 1 of 4 Prior Authorization Review Panel A separate copy of this ...
CLINICAL POLICY. Trabectedin (Yondelis). Page 2 of 4. Clinical Policy: Trabectedin (Yondelis). Reference Number: PA.CP.PHAR.204. Effective Date: 01/2018. Coding ...
Effective March 1, 2024: Pharmacy and Biopharmacy Policies
Per National Comprehensive Cancer Network added off-label indication criteria for mesothelioma. Trabectedin (Yondelis) (CP.PHAR.204). Ambetter ...
YONDELIS- trabectedin injection, powder, lyophilized, for solution
YONDELIS is indicated for the treatment of patients with unresectable or metastatic liposarcoma or leiomyosarcoma who received a prior anthracycline-containing ...
Clinical & Payment Policies | Provider Resources - Coordinated Care
... (CP.PHAR.668); Trabectedin (Yondelis) (PDF) (CP.PHAR.204); Tralokinumab-ldrm (Adbry) (PDF) (CP.PHAR.577); Trametinib (Mekinist) (PDF) (CP.PHAR.240); Transmucosal ...
Medicaid Criteria Updates - Q1 2018 - Buckeye Health Plan
CP.PHAR.204 Trabectedin. (Yondelis®). Significant. Clinical. Change(s). Medicaid. 1Q18 annual review: - Initial: Added age requirement as safety and efficacy ...
NH Healthy Families Pharmacy & Therapeutics Committee 1Q19. CP.PHAR.204 Trabectedin (Yondelis) coverage of STS is expanded to encompass STS subtypes of non ...
Clinical & Payment Policies - Nebraska Total Care
Pharmacy Policies A-E (Generic name). Pharmacy Policies A-E. Rx Policy ... trabectedin (Yondelis) (PDF), CP.PHAR.204, 02/14/2019. Trastuzumab (Herceptin) ...
Clinical & Payment Policies - Arkansas Total Care
CP.MP.163, April 1, 2024. Trabectedin (Yondelis) (PDF), CP.PHAR.204, February 1, 2024. Tralokinumab-ldrm (Adbry) (PDF), CP.PHAR.577, June 1, 2022. Transcatheter ...
Clinical & Payment Policies - Western Sky Community Care
... clinical areas affected by the policy; and other available clinical information. ... CP.PHAR.204 (PDF), Trabectedin (Yondelis), 5/1/16. CP.PHAR.577 (PDF) ...
Clinical Payment Policies | Ambetter from Coordinated Care
... (CP.PMN.281); Topotecan (Hycamtin) (PDF) (CP.PHAR.64); Trabectedin (Yondelis®) (PDF) (CP.PHAR.204); Tralokinumab-ldrm (Adbry) (PDF) (CP.PHAR.577); Trametinib ...
FDA Approval Summary: Trabectedin for Unresectable or Metastatic ...
Dacarbazine, N = 173 . PFS. PFS events, n (%), 217 (63%), 112 (65%). Disease progression, 204 (59 ...
Clinical and Payment Policies - Meridian Health Plan of Illinois
Trabectedin (Yondelis) (CP.PHAR.204) (PDF) · Trametinib (Mekinist) (CP.PHAR.240) (PDF) · Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (CP.PHAR.228) (PDF) ...
Pharmacy Information and Preferred Drug List Changes – 1st ...
CP.PHAR.204 Trabectedin (Yondelis). CP.PHAR.224 Enoxaparin (Lovenox) ... CP.PHAR.254 Infliximab (Avsola, Inflectra, Remicade,. Renflexis ...
Clinical, Payment & Pharmacy Policies - Superior HealthPlan
Tovorafenib (Ojemda) (CP.PHAR.686) (PDF) · Trabectedin (Yondelis) (CP.PHAR.204) (PDF) · Tralokinumab-ldrm (Adbry) (CP.PHAR.577) (PDF) · Trametinib (Mekinist) ( ...
Clinical & Payment Policies - Louisiana Healthcare Connections
LA.PHAR.204 Trabectedin (Yondelis) (PDF) · LA.PHAR.212 Dornase Alfa ... Trabectedin (Yondelis) CP.PHAR.204 (PDF) · Tralokinumab-ldrm (Adbry) CP.PHAR ...
Clinical Payment Policy | Georgia Medicaid - Peach State Health Plan
Drugs of Abuse: Definitive Drug Testing (PDF), CP.MP.50. Durable Medical ... Trabectedin (Yondelis®) (PDF), CP.PHAR.204, May 1, 2016. Trametinib (Mekinist) ...
TCHP - Provider Update 2021 - Trillium Community Health Plan
CP.PHAR.204 Trabectedin (Yondelis). CP.PMN.141 Dolasetron (Anzemet) ... CP.PHAR.208 Sodium phenylbutyrate (Buphenyl) CP.PMN.159 ...
Policies - Arizona Complete Health
CP.PHAR.345, 02/22. Acetylcholinesterase Inhibitors (Aricept, Aricept ODT ... Trabectedin (Yondelis®) (PDF), CP.PHAR.204, 02/21. Trametinib (Mekinist) (PDF) ...