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Verzenio (abemaciclib) — Highmark

HR-positive, HER2-negative advanced or metastatic breast cancer following endocrine therapy and prior chemotherapy in the metastatic setting (monotherapy)

Initial criteria

  • age ≥ 18 years
  • disease is HR-positive, HER2-negative (ICD-10: C50)
  • Verzenio is used for one of the following: (A) node-positive early breast cancer at high risk of recurrence, in combination with endocrine therapy, as adjuvant treatment OR (B) advanced/metastatic breast cancer as initial endocrine-based therapy in combination with an aromatase inhibitor OR (C) advanced/metastatic breast cancer after disease progression on endocrine therapy in combination with fulvestrant OR (D) advanced/metastatic breast cancer after endocrine therapy and prior chemotherapy in the metastatic setting, as monotherapy

Reauthorization criteria

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

Approval duration

12 months