Lynparza (olaparib) — CareFirst (Caremark)

Initial criteria

• Member has completed ≥ 2 lines of platinum-based therapy for recurrent disease, has a deleterious or suspected deleterious germline or somatic BRCA mutation, and will be using the requested medication as a single agent
• OR Member has a deleterious or suspected deleterious germline or somatic BRCA mutation and will be using the requested medication as a single agent for advanced (stage II–IV) disease
• OR Member has received primary therapy that includes bevacizumab for advanced (stage II–IV) disease, will be using the requested medication in combination with bevacizumab, AND member has homologous recombination deficiency (HRD) positive disease OR has a deleterious or suspected deleterious germline or somatic BRCA mutation

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on current regimen
• Maximum treatment duration for first-line maintenance BRCA-mutated advanced ovarian cancer in complete response = 2 years
• Maximum treatment duration when used with bevacizumab in complete response = 2 years

Approval duration

12 months