Verzenio — United Healthcare

Initial criteria

• Diagnosis of breast cancer
• Disease is hormone-receptor (HR)-positive
• Disease is human epidermal growth factor receptor 2 (HER2)-negative
• One of the following:
• • Both of the following: Disease is advanced, recurrent, or metastatic AND one of the following: Used in combination with an aromatase inhibitor (e.g., anastrozole, letrozole, exemestane) or Faslodex (fulvestrant) OR All of the following: Used as monotherapy; patient has disease progression following endocrine therapy; patient has already received at least one prior chemotherapy regimen
• OR
• • All of the following: Disease is early breast cancer at high risk of recurrence defined by ≥4 positive lymph nodes OR (1–3 positive lymph nodes AND Grade 3 disease or tumor size ≥5 cm); used in combination with an aromatase inhibitor (e.g., anastrozole, letrozole, exemestane) or tamoxifen; use has not exceeded two years in duration

Reauthorization criteria

• One of the following:
• • Both of the following: Diagnosis of advanced, recurrent, or metastatic breast cancer AND patient does not show evidence of progressive disease while on Verzenio therapy
• OR
• • All of the following: Diagnosis of early breast cancer at high risk of recurrence; patient does not show evidence of progressive disease while on Verzenio therapy; use has not exceeded two years in duration

Approval duration

12 months