HALAVEN (eribulin)

HALAVEN (eribulin)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

• Refractory metastatic breast cancer

All of the following must be met as a condition(s) for coverage:

• Single drug therapy for the treatment of metastatic breast cancer
• Previous therapy with two National Comprehensive Cancer Network (NCCN) recommend chemotherapeutic regimens for the treatment of metastatic disease
• Patient has had therapy or has a contraindication to therapy with and anthracycline and a taxane

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

• Any other diagnosis not listed in the approved indications

Dosing:

• The recommended dose is up to 1.4 mg/m2 IV on days one and eight of a 21 day cycle

Approval:

One year