Kisqali Femara Co-Pack (ribociclib; letrozole) — Highmark
HR-positive, HER2-negative advanced or metastatic breast cancer (initial endocrine-based therapy)
Initial criteria
- age ≥ 18 years
- for early breast cancer: diagnosis of HR-positive, HER2-negative stage II or III disease at high risk of recurrence, used as adjuvant therapy
- for advanced or metastatic disease: diagnosis of HR-positive, HER2-negative advanced or metastatic breast cancer (ICD-10: C50), used as initial endocrine-based 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