Ibrance (palbociclib) — Highmark
HR-positive, HER2-negative advanced or metastatic breast cancer in combination with fulvestrant following disease progression on endocrine therapy
Preferred products
- Kisqali
- Verzenio
Initial criteria
- age ≥ 18 years
- diagnosis of advanced or metastatic breast cancer (ICD-10: C50)
- disease is HR-positive, HER2-negative
- Ibrance is being used either (A) as initial endocrine-based therapy in combination with an aromatase inhibitor OR (B) after disease progression on endocrine therapy in combination with fulvestrant
- member has experienced therapeutic failure, contraindication, or intolerance to one (1) of the following plan-preferred products: Kisqali OR Verzenio
Reauthorization criteria
- member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months