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Drug - Erivedge (vismodegib) [Genentech, Inc]

January 2013

Therapeutic area - Oral Oncology

Approval criteria

  • Patient has diagnosis of metastatic basal cell carcinoma (BCC) AND
  • Patient has exhausted surgical and radiation options for treating advanced BCC

Quantity limit

Quantity Limit = 34 tablets

Background information

ERIVEDGE™ (vismodegib) capsule is a hedgehog pathway inhibitor indicated for the treatment of adults with metastatic basal cell carcinoma, or with locally advanced basal cell carcinoma that has recurred following surgery or who are not candidates for surgery, and who are not candidates for radiation. The 2012 NCCN guidelines recommend enrolling the patient in a clinical trial as the preferred options for patients with residual BBC where further surgery and radiation are contraindicated. The dose of vismodegib is 150 mg once daily.

Erivedge is subject to quantity level limits and prior authorization.


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

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