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Drug - Cabometyx® (cabozantinib) [Exelixis,Inc.]

January 2018

Therapeutic area - Oncology

Initial approval criteria

  • Patient is 18 years of age or older AND
  • Must have a diagnosis of advanced renal cell carcinoma (RCC) AND
  • Must have received prior anti-angiogenic therapy AND
  • Must not have recent history of hemorrhage not due to trauma AND
  • Must be used as monotherapy AND
  • Documentation of diagnosis from patient’s medical records must be provided at time of request

Renewal criteria

  • Documentation must be supplied at time of request showing patient has no disease progression AND
  • Must not have any one of the following:
    • Hemorrhage not due to trauma
    • Unmanaged gastrointestinal perforations or fistulas
    • Palmar-plantar erythrodysesthesia syndrome Grade 2 or 3
    • Uncontrolled severe hypertension


Initial and renewal approval will be for 6 months

Quantity limits

34 tablets per 34 days


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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