Eribulin mesylate (Halaven) — Coverage Criteria
Medical necessity and prior authorization criteria for Eribulin mesylate (Halaven) for metastatic breast cancer and select soft tissue sarcoma indications across Health Net lines of business.
For breast cancer, combination with trastuzumab and Margenza revised to be fourth-line therapy or beyond per NCCN update.
Soft tissue sarcoma criteria simplified to require disease be advanced, metastatic, recurrent, or unresectable; removed coverage for angiosarcoma and solitary fibrous tumor per NCCN updates.
Added combination therapy with Margenza as an option for HER2-positive breast cancer in fourth-line therapy or beyond.
Dose limit clarified: does not exceed 1.4 mg/m2 on days 1 and 8 of a 21-day cycle.
For breast cancer, trastuzumab and Margenza combination therapy options with Halaven revised to be fourth-line therapy or beyond per NCCN update.
Coverage for angiosarcoma and solitary fibrous tumor removed as use is no longer supported by NCCN Soft Tissue Sarcoma guidelines.
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