Piqray (alpelisib) — Highmark

Initial criteria

• age ≥ 18 years
• Diagnosis of advanced or metastatic breast cancer (ICD-10: C50)
• Used in combination with fulvestrant
• Disease progression on or after an endocrine-based regimen
• Tumor is HR-positive, HER2-negative
• PIK3CA mutation-positive as detected by an FDA-approved test

Reauthorization criteria

• Prescriber attests the member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression

Approval duration

12 months