Kisqali (ribociclib) — Highmark
HR-positive, HER2-negative stage II or III early breast cancer at high risk of recurrence (adjuvant therapy in combination with an aromatase inhibitor)
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 in combination with an aromatase inhibitor
- for advanced/metastatic disease: diagnosis of HR-positive, HER2-negative advanced or metastatic breast cancer (ICD-10: C50)
- Kisqali is used either (A) with an aromatase inhibitor as initial endocrine-based therapy OR (B) with fulvestrant as initial endocrine-based therapy OR after disease progression on 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