Methitest — Highmark
Palliative treatment in metastatic breast cancer
Preferred products
- generic methyltestosterone capsules
Initial criteria
- Member is female
- Diagnosis of metastatic breast cancer (ICD-10: C50)
- Drug used for palliative treatment
- Request is for testosterone cypionate (IM), testosterone enanthate oil for injection, or methyltestosterone
- If request is for brand Methitest, member has experienced therapeutic failure or intolerance to plan-preferred generic methyltestosterone capsules
Reauthorization criteria
- Prescriber attests member has experienced positive clinical response to testosterone therapy
- Member requires continued therapy with a testosterone product
Approval duration
12 months