Braftovi (encorafenib) — CareFirst (Caremark)

Cutaneous melanoma with BRAF V600 mutation-positive adjuvant therapy of resected stage III disease

Preferred products

Diagnosis of cutaneous melanoma with documented BRAF V600 mutation (e.g., V600E or V600K) confirmed by FDA-approved or validated test
If unresectable or metastatic disease: either (a) used in combination with binimetinib (Mektovi) or (b) used as a single agent if BRAF/MEK inhibitor combination therapy is contraindicated
If used as neoadjuvant therapy, must be in combination with binimetinib (Mektovi) when immunotherapy is contraindicated AND member experienced unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) or dabrafenib/trametinib are less desirable based on side-effect profiles
If used as adjuvant treatment of resected stage III disease, must be in combination with binimetinib (Mektovi) AND member experienced unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) or dabrafenib/trametinib are less desirable based on side-effect profiles
If used for limited resectable local satellite/in-transit recurrent disease, must be in combination with binimetinib (Mektovi) AND member experienced unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) or dabrafenib/trametinib are less desirable based on side-effect profiles

No evidence of disease progression or unacceptable toxicity while on current regimen

12 months