Vijoice (alpelisib) — Point32Health

Initial criteria

• Documented diagnosis of PIK3CA-Related Overgrowth Spectrum
• The patient is age ≥ 2 years
• Documentation the patient’s condition is severe or life-threatening as determined by the treatment physician

Reauthorization criteria

• Documented diagnosis of PIK3CA-Related Overgrowth Spectrum
• The patient is age ≥ 2 years
• Documentation the patient has not experienced disease progression while receiving the requested medication

Approval duration

initial 6 months; reauth 12 months