Piqray (alpelisib) — CareFirst (Caremark)
HR-positive, HER2-negative, PIK3CA-mutated recurrent, advanced or metastatic breast cancer
Initial criteria
- Diagnosis of HR-positive, HER2-negative, PIK3CA-mutated recurrent, advanced, or metastatic breast cancer confirmed by documentation of HR and HER2 status and PIK3CA mutation
- Requested drug is used in combination with fulvestrant
- Disease has progressed while on or after an endocrine-based regimen
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on treatment
Approval duration
12 months