Lynparza (olaparib) — CareFirst (Caremark)

Initial criteria

• EITHER used as a single agent (with concurrent GnRH analog or after bilateral orchiectomy) AND ALL:
• - Member has deleterious or suspected deleterious germline or somatic HRR gene mutation (including BRCA1, BRCA2, ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L)
• - Member has progressed on prior androgen receptor-directed therapy
• - Member is receiving concurrent luteinizing hormone-releasing hormone (LHRH) agonist (e.g., goserelin, leuprolide) or antagonist (e.g., degarelix, relugolix) or has had bilateral orchiectomy
• OR used in combination with abiraterone or fine-particle abiraterone (Yonsa) and concurrent steroids (prednisone, prednisolone, or methylprednisolone) AND ALL:
• - Member has deleterious or suspected deleterious BRCA mutation
• - Member has not progressed on prior novel hormone therapy (e.g., abiraterone, enzalutamide, darolutamide, or apalutamide)
• - Member is receiving concurrent LHRH agonist or antagonist or has had bilateral orchiectomy

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression

Approval duration

12 months