Ibrance (palbociclib) — Highmark
endocrine-resistant, PIK3CA-mutated, HR-positive, HER2-negative locally advanced or metastatic breast cancer following recurrence on or after completing adjuvant endocrine therapy, in combination with Itovebi (inavolisib) and fulvestrant
Initial criteria
- age ≥ 18 years
- diagnosis of endocrine-resistant, locally advanced or metastatic breast cancer (ICD-10: C50)
- disease is HR-positive, HER2-negative
- disease is PIK3CA-mutated as detected by an FDA-approved test
- Ibrance is used in combination with inavolisib (Itovebi) AND fulvestrant
- recurrence occurred on or after completion of adjuvant endocrine therapy
Reauthorization criteria
- member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months