Itovebi (inavolisib tablets - Genentech) — Cigna

Breast cancer

Initial criteria

Patient is age ≥ 18 years; AND
Patient meets ONE of the following (i or ii): i) Patient is a postmenopausal female; OR ii) Patient is a pre/perimenopausal female or a male AND meets ONE of the following (a or b): a) Patient is receiving a gonadotropin-releasing hormone (GnRH) agonist; OR b) Patient has had surgical bilateral oophorectomy or ovarian irradiation (female) or orchiectomy (male); AND
Patient has locally advanced or metastatic hormone receptor (HR)-positive disease; AND
Patient has human epidermal growth factor receptor 2 (HER2)-negative disease; AND
Patient has PIK3CA-mutated breast cancer as detected by an approved test; AND
Patient meets ONE of the following (i or ii): i) Patient has disease progression while on adjuvant endocrine therapy; OR ii) Patient has had disease recurrence within 12 months after completing adjuvant endocrine therapy; AND
The medication will be used in combination with Ibrance (palbociclib) and fulvestrant injection.

1 year