Votrient (pazopanib)
Indications for Prior Authorization
Votrient (pazopanib)
-
For diagnosis of Renal Cell Carcinoma (RCC)
Indicated for the treatment of patients with advanced renal cell carcinoma (RCC). -
For diagnosis of Soft tissue sarcoma (STS)
Indicated for the treatment of patients with advanced soft tissue sarcoma (STS) who have received prior chemotherapy.Limitation of Use: The efficacy of Votrient for the treatment of patients with adipocytic STS or gastrointestinal stromal tumors has not been demonstrated.
Criteria
Brand Votrient, Generic pazopanib
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
For diagnosis of Renal Cell Carcinoma (RCC)
- Diagnosis of renal cell carcinoma AND
- One of the following: [2]
- Disease has relapsed
- Diagnosis of stage IV disease
- Trial and failure, or intolerance to generic pazopanib (applies to brand Votrient only) AND
- One of the following: [2]
- One of the following:
- Both of the following:
- Used in the treatment of non-clear cell renal cell carcinoma
- Trial and failure, contraindication or intolerance to generic sunitinib
- For continuation of prior therapy
- Patient has clear cell renal cell carcinoma
Brand Votrient, Generic pazopanib
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Renal Cell Carcinoma (RCC)
- Patient does not show evidence of progressive disease while on therapy AND
- Trial and failure, or intolerance to generic pazopanib (applies to brand Votrient only) AND
- One of the following:
- One of the following:
- Both of the following:
- Used in the treatment of non-clear cell renal cell carcinoma
- Trial and failure, contraindication or intolerance to generic sunitinib
- For continuation of prior therapy
- Patient has clear cell renal cell carcinoma
Brand Votrient, Generic pazopanib
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
For diagnosis of Soft tissue sarcoma (STS)
- Diagnosis of advanced soft tissue sarcoma (STS) [4, A] AND
- Trial and failure, or intolerance to generic pazopanib (Applies to Brand Votrient only)
Brand Votrient, Generic pazopanib
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Soft tissue sarcoma (STS)
- Patient does not show evidence of progressive disease while on therapy AND
- Trial and failure, or intolerance to generic pazopanib (Applies to Brand Votrient only)
P & T Revisions
2025-12-09, 2025-03-03, 2024-02-19, 2023-11-23, 2023-06-22, 2023-06-08, 2023-03-21, 2023-03-21, 2022-08-01, 2022-03-02, 2021-09-27, 2021-05-25, 2021-04-13, 2020-03-12
References
- Votrient Prescribing Information. Novartis Pharmaceuticals. East Hanover, NJ. January 2024.
- National comprehensive cancer network (NCCN). Clinical practice guidelines in oncology. Kidney cancer v.3.2025. Available at: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf. Accessed February 28, 2025.
- PALETTE: a randomized, double-blind, phase III trial of pazopanib versus placebo in patients (pts) with soft-tissue sarcoma (STS) whose disease has progressed during or following prior chemotherapy-An EORTC STBSG Global Network Study (EORTC 62072). Available at: www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=102&abstractID=83283. Accessed April 30, 2012.
- National comprehensive cancer network (NCCN). Clinical practice guidelines in oncology. Soft tissue sarcoma v.4.2024. Available at: http://www.nccn.org/professionals/physician_gls/PDF/sarcoma.pdf. Accessed February 28, 2025.
- Pazopanib Prescribing Information. Torrent Pharmaceuticals Limited. India. October, 2025.
End Notes
- Votrient is an active drug in anthracycline pretreated STS patients with an increase in median PFS of 13 weeks. [3]
Revision History
- 2025-12-09: Addition of new strength of generic. Added IL statute operational note.
- 2025-03-03: 2025 Annual Review. Background updates only.
- 2024-02-19: 2024 Annual Review
- 2023-11-23: Addition of generic Votrient, PA applied.
- 2023-06-22: Removed Oncology specialist requirement
- 2023-06-08: Update for Soft Tissue Sarcoma to remove criterion that requires "patient received at least one prior chemotherapy."
- 2023-03-21: Annual Review: Updated Soft Tissue Sarcoma criteria to remove listed chemotherapy examples.
- 2023-03-21: COT allowance to support formulary strategy for non-clear cell renal cell carcinoma.
- 2022-08-01: Guideline Update
- 2022-03-02: No criteria changes, updated references.
- 2021-09-27: Addition of EHB formulary to guideline, no changes to criteria
- 2021-05-25: Addition of EHB formulary to guideline, no changes to criteria
- 2021-04-13: 2021 Annual Review: no changes. Updated GPIs
- 2020-03-12: Annual Review: updated background & references
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