Orserdu (elacestrant) — Highmark
advanced or metastatic ER-positive, HER2-negative, ESR1-mutated breast cancer
Initial criteria
- age ≥ 18 years
- member is a male or a postmenopausal female
- diagnosis of advanced or metastatic breast cancer (ICD-10: C50)
- disease is ER-positive, HER2-negative
- disease harbors an ESR1 mutation as detected by an FDA-approved test
- disease progression following at least one line of endocrine therapy
Reauthorization criteria
- prescriber attests that the member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
12 months