BRUKINSA (zanubrutinib)

BRUKINSA (zanubrutinib)

SELF-ADMINISTRATION- ORAL 

Indications for Prior Authorization:

• Indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL) who have received ≥ 1 prior therapy

Coverage Criteria:

• Dose does not exceed 320 mg orally (four 80 mg capsules) once daily; AND 

• Prescribed by or in consultation with an oncologist; AND

• Patient is 18 years of age or older; AND

• Diagnosis of mantle cell lymphoma (relapsed or refractory); AND

• Patient has failed to respond to at least 1 prior therapy

Coverage Duration:

• 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.

Additional Information:

• Precautions:

  • Avoid co-administration with moderate/strong CYP3A inducers

  • Use in specific populations:

    • Breast-feeding considerations: not recommended by the manufacturer during therapy or for ≥ 2 weeks following the last Brukinsa dose

• Dosage and administration:

  • Severe hepatic impairment: the recommended dose is 80 mg twice daily

Policy Updates:

• 02/18/2020 - Initial review

• 06/01/2023 - Updating policy to include dosing/prescriber requirements for MCL and formatting

References:

• Brukinsa Prescribing Information.  BeiGene USA, Inc.  San Mateo, CA.  April 2023.