Tykerb (lapatinib) — Highmark

Preferred products

• lapatinib (generic)

Initial criteria

• age ≥ 18 years
• EITHER use in combination with capecitabine AND diagnosis of advanced or metastatic HER2-positive breast cancer (ICD-10: C50) AND received prior therapy including anthracycline, taxane, and trastuzumab OR use in combination with letrozole AND post-menopausal AND diagnosis of hormone receptor-positive metastatic breast cancer (ICD-10: C50) that overexpresses HER2
• if request is for brand Tykerb, member has experienced therapeutic failure or intolerance to generic lapatinib

Reauthorization criteria

• prescriber attests that the member is tolerating therapy
• member has experienced a therapeutic response defined as disease improvement OR delayed disease progression
• if request is for brand Tykerb, documentation that AB-rated generic is ineffective or not tolerated

Approval duration

12 months