Mekinist oral solution — Blue Cross Blue Shield of Montana

stage four advanced metastatic cancer or associated condition

Preferred products

Patient weighs less than 26 kg OR BOTH of the following:
The prescriber has stated or submitted documentation that the patient has been diagnosed with stage four advanced, metastatic cancer and the requested agent is being used to treat the cancer or an associated condition [chart notes required]
The use of the requested agent is consistent with best practices for the treatment of stage four advanced, metastatic cancer or associated condition; supported by peer-reviewed, evidence-based literature; and approved by the FDA
OR patient is currently treated with and stable on requested agent [chart notes required]
OR patient has tried and had inadequate response to Mekinist oral tablets [chart notes required]
OR Mekinist oral tablets discontinued for lack of efficacy, effectiveness, or adverse event [chart notes required]
OR patient has intolerance, hypersensitivity, or labeled contraindication to Mekinist oral tablets not expected with requested agent [chart notes required]
OR Mekinist oral tablets expected to be ineffective or cause adherence/comorbidity/functional/adverse issues [chart notes required]
OR Mekinist oral tablets not in best interest of patient based on medical necessity [chart notes required]
OR patient has tried another drug in same class/mechanism as Mekinist oral tablets and discontinued due to lack of efficacy, diminished effect, or adverse event [chart notes required]
OR support for use of requested agent over Mekinist oral tablets (e.g., swallowing difficulties)

12 months