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Kisqali Femara Co-Pack (ribociclib/letrozole)United Healthcare

Early-stage (II or III) breast cancer at high risk of recurrence

Initial criteria

  • Diagnosis of early-stage (II or III) breast cancer at high risk of recurrence
  • AND one of the following: Disease is node-positive OR (Disease is node-negative AND (Tumor size > 5 cm OR (Tumor size 2–5 cm AND (Grade 2 and high genomic risk or Ki-67 ≥ 20% OR Grade 3))))
  • AND Disease is hormone receptor (HR)-positive
  • AND Disease is human epidermal growth factor receptor 2 (HER2)-negative

Reauthorization criteria

  • Patient does not show evidence of progressive disease while on Kisqali Femara Co-Pack therapy

Approval duration

12 months