Itovebi — CareFirst (Caremark)
Recurrent breast cancer
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