cobimetinib — CareFirst (Caremark)
Cutaneous melanoma with BRAF V600 mutation-positive (e.g., BRAF V600E or V600K mutations)
Preferred products
- dabrafenib
- Tafinlar
- trametinib
- Mekinist
Initial criteria
- Adult patient
- Documentation of BRAF V600 mutation-positive (e.g., BRAF V600E or V600K)
- Unresectable or metastatic cutaneous melanoma when used in combination with vemurafenib (Zelboraf) with or without atezolizumab (Tecentriq) or atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza), OR
- Neoadjuvant therapy in combination with vemurafenib (Zelboraf) if immunotherapy is contraindicated AND member has had unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) OR dabrafenib/trametinib are less desirable based on side-effect profiles, OR
- Adjuvant treatment of resected stage III disease in combination with vemurafenib (Zelboraf) when the member has had unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) OR dabrafenib/trametinib are less desirable based on side-effect profiles, OR
- Limited resectable local satellite/in-transit recurrent disease in combination with vemurafenib (Zelboraf) when the member has had unacceptable toxicity to dabrafenib (Tafinlar) plus trametinib (Mekinist) OR dabrafenib/trametinib are less desirable based on side-effect profiles
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
12 months