abemaciclib — CareFirst (Caremark)

Initial criteria

• Member has hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, early breast cancer
• Requested medication is used as adjuvant treatment in combination with endocrine therapy (tamoxifen or an aromatase inhibitor)
• Member has either four or more positive lymph nodes OR one to three positive lymph nodes and at least one of the following: grade 3 disease OR tumor size ≥ 5 cm

Reauthorization criteria

• Continued treatment until completion of 2 years of treatment or until disease recurrence or unacceptable toxicity while on the current regimen

Approval duration

12 months