Braftovi (encorafenib capsules − Array) — Cigna

Colon or Rectal Cancer

Initial criteria

Patient age ≥ 18 years
Patient has BRAF V600E mutation-positive disease
Patient meets ONE of the following (i or ii):
i. Patient meets ALL of the following (a, b, and c):
a) The medication will be used as first-line systemic therapy for metastatic disease
b) The medication will be used in combination with Erbitux (cetuximab intravenous infusion) or Vectibix (panitumumab intravenous infusion)
c) The medication will be used in combination with FOLFOX (5-FU, leucovorin, and oxaliplatin)
OR
ii. Patient meets BOTH of the following (a and b):
a) Patient has previously received a chemotherapy regimen for colon or rectal cancer
b) The medication is used in combination with Erbitux or Vectibix

1 year