Mekinist oral solution — Blue Cross Blue Shield of New Mexico

Preferred products

• Mekinist oral tablets

Initial criteria

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

Approval duration

12 months