elacestrant — CareFirst (Caremark)

Initial criteria

• The disease is ER-positive, HER2-negative, and ESR1-mutated
• Member has received at least one prior line of endocrine therapy including one line containing a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor (e.g., abemaciclib [Verzenio], palbociclib [Ibrance], ribociclib [Kisqali])
• Member has either had no response to preoperative systemic therapy OR has advanced, metastatic, or recurrent disease
• The requested medication will be used as a single agent

Reauthorization criteria

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

Approval duration

12 months