Braftovi (encorafenib) — CareFirst (Caremark)
Metastatic or advanced colorectal cancer (including appendiceal or anal adenocarcinoma) with BRAF V600E mutation
Initial criteria
- Tumor positive for BRAF V600E mutation confirmed by FDA-approved or validated test
- Used in combination with cetuximab (Erbitux) or panitumumab (Vectibix)
- Either (a) used as subsequent therapy for advanced or metastatic disease OR (b) used as primary therapy for unresectable metachronous metastases AND member received FOLFOX (fluorouracil, leucovorin, and oxaliplatin) or CapeOX (capecitabine and oxaliplatin) within past 12 months
Reauthorization criteria
- No evidence of disease progression or unacceptable toxicity while on current regimen
Approval duration
12 months