Verzenio (abemaciclib)
Defines clinical and utilization management criteria for coverage of Verzenio (abemaciclib) for breast cancer indications, continuation rules, exclusions, dosing limits, and approval authority for Neighborhood Health Plan of Rhode Island (processed by Evolent).
Policy approved November 13, 2024 with effective date November 29, 2024 (committee review history updated).
Coverage Summary
Coverage stance: covered_with_criteria for Verzenio (abemaciclib) for both high-risk early-stage (adjuvant) and recurrent/metastatic HR+/HER2- breast cancer per the brief. Scope summary: defines clinical and utilization management criteria including indication-specific eligibility, continuation rules, dosing and quantity limits, exclusions, and approval authority for Neighborhood Health Plan of Rhode Island (processed by Evolent). Required evidence sources: supporting documentation must include one or more of the following — FDA-approved product labeling, CMS-recognized compendia, NCCN or ASCO clinical guidelines, or peer-reviewed literature that meets CMS Medicare Benefit Policy Manual Chapter 15 requirements.