WHA
 

Demser (metyrosine)

Indications for Prior Authorization

Demser (metyrosine)
  • For diagnosis of Pheochromocytoma
    Indicated in the treatment of patients with pheochromocytoma for preoperative preparation of patients for surgery, management of patients when surgery is contraindicated, and chronic treatment of patients with malignant pheochromocytoma. DEMSER (metyrosine) capsules are not recommended for the control of essential hypertension.

Criteria

Brand Demser, generic metyrosine

Prior Authorization

Length of Approval: 1 Time(s)
For diagnosis of Preoperative Preparation

  • Diagnosis of pheochromocytoma confirmed by one of the following biochemical tests [A]:
    • plasma free metanephrines
    • urinary fractioned metanephrines
    AND
  • Medication is being used for preoperative preparation [B]
    • AND
  • Trial and failure, contraindication, or intolerance to both of the following [B]:
    • alpha-adrenergic blocker (e.g., phenoxybenzamine, doxazosin, terazosin)
    • beta-adrenergic blocker (e.g., propranolol, metoprolol)
    AND
  • Prescribed by or in consultation with one of the following:
    • Endocrinologist
    • Endocrine surgeon
Brand Demser, generic metyrosine

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Treatment of Pheochromocytoma [C]

  • Diagnosis of pheochromocytoma confirmed by one of the following biochemical tests [A]:
    • plasma free metanephrines
    • urinary fractioned metanephrines
    AND
  • Patient with hormonally active (catecholamine excess) pheochromocytoma
    • AND
  • One of the following:
    • Patient is not a candidate for surgery
      • OR
    • Chronic treatment due to malignant pheochromocytoma
    AND
  • Patient has not reached normotension after treatment with a selective alpha-1-adrenergic blocker (e.g., doxazosin, terazosin) and beta-adrenergic blocker (e.g., propranolol, metoprolol)
    • AND
  • Medication will not be used to control essential hypertension
    • AND
  • Prescribed by or in consultation with one of the following:
    • Endocrinologist
    • Provider who specializes in the management of pheochromocytoma
Brand Demser, generic metyrosine

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Treatment of Pheochromocytoma [C]

  • Patient demonstrates positive clinical response to therapy (e.g., decreased frequency and severity of hypertensive attacks)

  • Guideline ID
    GL-532187

  • Formulary
    EHB

  • Effective date
    May 1, 2026

  • P&T approval date
    Mar 16, 2022

P & T Revisions

2026-03-02, 2025-12-18, 2025-12-18, 2025-02-14, 2024-03-14, 2023-09-13, 2023-03-01, 2022-10-26, 2022-03-01

  1. Demser Prescribing Information. Bausch Health US, LLC. Bridgewater, NJ. July 2021.
  2. Lenders JWM, Duh Q-Y, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014; 99(6):1915-1942.
  3. Metyrosine Prescribing Information. Amneal Pharmaceuticals LLC. Bridgewater, NJ. November 2020.
  4. Fishbein L, Del Rivero J, Else T, et al. The North American Neuroendocrine Tumor Society Consensus Guidelines for surveillance and management of metastatic and/or unresectable pheochromocytoma and paraganglioma. Pancreas. 2021; 50(4):469-493.
  5. Young WF, Kebebew E, Nieman LK, et al. Treatment of pheochromocytoma in adults. Wolters Kluwer. Updated September 11, 2025. Available with subscription from: https://www.uptodate.com. Accessed March 2, 2026.
  6. Young WF, Wen PY, Shah SM. Management of malignant (metastatic) paraganglioma and pheochromocytoma. Wolters Kluwer. Updated October 20, 2025. Available with subscription from: https://www.uptodate.com. Accessed March 2, 2026.
  1. All patients should have plasma-free metanephrines or 24-hour urine metanephrines measured in the laboratory work-up to diagnose patients with pheochromocytoma. [2, 4]
  2. Preoperative medical therapy targets controlling hypertension (including hypertensive crisis prevention during surgery), tachycardia, and volume expansion. Combined alpha and beta-adrenergic blockade are suggested for preoperative preparation in patients with pheochromocytoma. [4, 5]
  3. All patients with metastatic pheochromocytoma confirmed to be catecholamine-secreting should have appropriate alpha- and beta-adrenergic blockage prior to receiving therapy for the tumor and associated metastatic disease. [6]
  • 2026-03-02: Annual Review 2026 - Updated diagnostic test criterion verbiage from biochemical testing to biochemical tests with no change to clinical intent. Background updates.
  • 2025-12-18: No criteria change, bulk copy oRX-EHB
  • 2025-12-18: no criteria changes, added IL statute operational note
  • 2025-02-14: 2025 Annual Review - no changes
  • 2024-03-14: 2024 Annual Review - no changes
  • 2023-09-13: Program update to standard reauthorization language. No changes to clinical intent.
  • 2023-03-01: 2023 Annual Review - no changes
  • 2022-10-26: Attached EHB Formulary
  • 2022-03-01: New Program