Mekinist oral solution — Blue Cross Blue Shield of Oklahoma
stage four advanced metastatic cancer or associated condition
Preferred products
- Mekinist oral tablets
Initial criteria
- ONE of the following:
- A. Patient weighs less than 26 kg OR
- B. BOTH of the following:
- 1. Diagnosis of stage four advanced, metastatic cancer and requested agent used to treat cancer or associated condition AND
- 2. Use consistent with best practices supported by peer-reviewed evidence and FDA approval OR
- C. Currently treated and stable on requested agent OR
- D. Tried and had inadequate response to Mekinist oral tablets OR
- E. Mekinist oral tablets discontinued due to lack of efficacy, diminished effect, or adverse event OR
- F. Intolerance or hypersensitivity to Mekinist oral tablets not expected with requested agent OR
- G. FDA labeled contraindication to Mekinist oral tablets not expected with requested agent OR
- H. Mekinist oral tablets expected to be ineffective, cause adherence barrier, worsen comorbidity, decrease function, or cause harm OR
- I. Mekinist oral tablets not in best interest of patient OR
- J. Tried another drug in same class as Mekinist oral tablets discontinued due to efficacy or adverse event OR
- K. Support for use over Mekinist oral tablets (e.g., swallowing difficulties)