Rubraca (rucaparib) — United Healthcare

Initial criteria

• Diagnosis of pancreatic adenocarcinoma
• Disease is metastatic
• Presence of one of the following: deleterious or suspected deleterious germline or somatic BRCA1/2 mutation OR deleterious or suspected deleterious germline or somatic PALB2 mutation
• Disease has not progressed while receiving at least 16 weeks of a first-line platinum-based chemotherapy regimen

Reauthorization criteria

• Patient does not show evidence of progressive disease while on Rubraca therapy

Approval duration

12 months