Tykerb (lapatinib ditosylate tablets – Novartis, generic) — Cigna

Breast cancer

Initial criteria

Patient age ≥ 18 years
Patient has human epidermal growth factor receptor 2 (HER2)-positive disease
Patient has recurrent or metastatic breast cancer
Patient meets ONE of the following (i or ii):
i) Patient meets BOTH of the following (a and b):
a) The medication will be used in combination with capecitabine or trastuzumab AND
b) Patient has tried at least three prior anti-HER2 based regimens
ii) The medication will be used in combination with an aromatase inhibitor (letrozole, anastrozole, or exemestane) AND patient meets the following (a and b):
a) Patient has hormone receptor-positive (HR+) disease
b) ONE of the following applies: (1) Patient is a postmenopausal woman OR (2) Patient is a premenopausal or perimenopausal woman receiving ovarian suppression/ablation with a gonadotropin-releasing hormone (GnRH) agonist, surgical bilateral oophorectomy, or ovarian irradiation OR (3) Patient is a man receiving a GnRH analog

1 year