Kisqali (ribociclib) — United Healthcare
Early-stage (II or III) breast cancer at high risk of recurrence
Preferred products
- anastrozole
- letrozole
- exemestane
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
- AND Used in combination with an aromatase inhibitor (e.g., anastrozole, letrozole, exemestane)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Kisqali therapy
Approval duration
12 months