Abemaciclib (Verzenio)
Defines medical necessity criteria, initial and continued therapy, approved and off-label covered indications (breast cancer, endometrial carcinoma, dedifferentiated liposarcoma), dosing limits, prescriber and documentation requirements, and approval durations for commercial, HIM, and Medicaid lines of business.
Added criteria for endometrial carcinoma as off-label indication supported by NCCN compendium and guidelines.
Added criteria for soft tissue sarcoma (dedifferentiated liposarcoma) as off-label indication supported by NCCN compendium and guidelines.
Clarified that combination use with an aromatase inhibitor should be for initial endocrine based therapy and premenopausal women require ovarian ablation/suppression.
Revised approval duration for Commercial line of business to 12 months or duration of request, whichever is less.