MEKTOVI (binimetinib)

SELF ADMINISTRATION - ORAL

 

Indications for Prior Authorization:
  • BRAF V600E or V600K unresectable or metastatic melanoma: Indicated in combination with Braftovi™ (encorafenib capsules), for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, as detected by an FDA approved test.
  • Non-Small Cell Lung Cancer (NSCLC): Indicated in combination with Braftovi (encorafenib) for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) with a BRAF V600E mutation, as detected by an FDA-approved test.

 

Coverage Criteria:

 

For diagnosis of melanoma:

  • Patient has unresectable, advanced, or metastatic melanoma, AND
  • Cancer is BRAF V600E or V600K mutant type as detected by an FDA-approved test (THxID-BRAF Kit) or performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA) AND
  • Mektovi will be used in combination with Braftovi™ (encorafenib capsules) AND
  • One of the following: 
    • Trial and failure, contraindication or intolerance to one of the following: 
      • Cotellic
      • Mekinist; OR
    • For continuation of prior therapy

 

For diagnosis of Non-Small Cell Lung Cancer (NSCLC):

  • Diagnosis of metastatic non-small cell cancer AND
  • Cancer is BRAF V600E mutant type as detected by an FDA-approved test (THxID-BRAF Kit) or performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA) AND
  • Used in combination with encorafenib

 

Reauthorization Criteria:

 

For diagnosis of all indications listed above:

  • Patient does not show evidence of progressive disease while on therapy

 

Dosing:
  • 45 mg orally taken twice daily in combination with encorafenib until disease progression or unacceptable toxicity.

 

Coverage Duration:

 

Initial: 1 year

Reauthorization: 1 year

 

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

 

Policy Updates:
  • 08/27/2019 - Initial review
  • 4/1/24 –Updated criteria to include NSCLC indication, Updated Melanoma indication to include trial and failure of Cotellic and Mekinist, Reauthorization Criteria added in

 

References:
  1. Mektovi Prescribing Information. Array Biopharma Inc. Boulder, CO. October 2023. 
  2. National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Melanoma: Cutaneous v.3.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf. Accessed May 23, 2022. 

 

 

Last review date: June 1, 2024