Vijoice (alpelisib) — CareFirst (Caremark)
PIK3CA-related overgrowth spectrum (PROS)
Initial criteria
- Member age ≥ 2 years
- Member has severe manifestations of disease and requires systemic therapy
- Member has a documented PIK3CA mutation
Reauthorization criteria
- No evidence of unacceptable toxicity or disease progression while on current regimen
Approval duration
Initial: 6 months; Reauthorization: 12 months