Mektovi — Cigna
Melanoma, BRAF V600 mutation-positive disease
Preferred products
- Cotellic
- Mekinist
Initial criteria
- Approve for 1 year if the patient meets ONE of the following (A or B):
- A) Patient meets BOTH of the following (i and ii):
- i. Patient meets the standard Oncology – Mektovi Prior Authorization Policy criteria; AND
- ii. Patient meets ONE of the following (a or b):
- a) Patient has tried one of Cotellic or Mekinist; OR
- b) Patient is currently receiving Mektovi;
- B) If the patient has met the standard Oncology – Mektovi PA Policy criteria, but has not met the exception criteria above (Aii), offer to review for one of the Preferred Products using either the standard Oncology – Cotellic PA Policy criteria or the Oncology – Mekinist PA Policy criteria.
Approval duration
1 year