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Orserdu — CareFirst (Caremark)

Postmenopausal women or adult men with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, ESR1-mutated advanced or metastatic breast cancer with disease progression following at least one line of endocrine therapy

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