Verzenio (abemaciclib tablets) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has recurrent or metastatic breast cancer
• Patient has hormone receptor positive (HR+) [estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+)] disease
• Patient meets ONE of the following (i or ii):
• i. Patient has HER2-negative breast cancer and meets ONE of the following (a, b, or c):
• a) Patient meets BOTH of the following [(1) and (2)]: (1) Patient is receiving a gonadotropin-releasing hormone (GnRH) analog AND (2) Verzenio will be used in combination with anastrozole, exemestane, or letrozole
• b) Verzenio will be used in combination with fulvestrant
• c) Patient meets ALL of the following [(1), (2), and (3)]: (1) Verzenio will be used as monotherapy AND (2) Patient’s breast cancer has progressed on at least one prior endocrine therapy AND (3) Patient has tried chemotherapy for metastatic breast cancer
• ii. Patient has HER2-positive breast cancer and meets BOTH of the following (a and b): (a) Patient has received at least three prior anti-HER2-based regimens in the metastatic setting AND (b) Verzenio will be used in combination with fulvestrant and trastuzumab

Approval duration

1 year