Verzenio Sgm 2342 A P2025
Defines coverage, prior authorization documentation, and authorization durations for Verzenio (abemaciclib) for FDA-approved and compendial oncology indications (early breast cancer, advanced/metastatic breast cancer, and endometrial carcinoma) when approval criteria are met.
No material clinical or coverage changes
Coverage Summary
Defines coverage, prior authorization documentation, and authorization durations for Verzenio (abemaciclib) for FDA‑approved and compendial oncology indications when approval criteria are met. Covered indications include early (adjuvant) HR‑positive, HER2‑negative, node‑positive high‑risk breast cancer (in combination with endocrine therapy), advanced/metastatic HR‑positive, HER2‑negative breast cancer (as initial endocrine‑based therapy in combination with an aromatase inhibitor, in combination with fulvestrant after progression on endocrine therapy, or as monotherapy after progression on endocrine therapy and prior chemotherapy), and recurrent/metastatic ER‑positive endometrial carcinoma when used in combination with letrozole per compendial guidance; prior authorization with documentation of receptor/HER2 status is required and authorization durations and reauthorization rules apply as specified in policy.
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