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Itovebi — CareFirst (Caremark)

Endocrine-resistant, PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer when used in combination with palbociclib and fulvestrant

Initial criteria

  • Member has a diagnosis of endocrine-resistant, PIK3CA-mutated, HR-positive, HER2-negative locally advanced, recurrent, or metastatic breast cancer
  • Therapy will be used in combination with palbociclib and fulvestrant
  • Documentation of test confirming presence of PIK3CA mutation is provided
  • Documentation of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status is provided

Reauthorization criteria

  • Member continues to meet the initial coverage criteria
  • There is no evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months