Ado-trastuzumab emtansine (Kadcyla®)
Indications for Prior Authorization
HER2 positive, metastatic breast cancer
All of the following must be met as a condition for coverage
Must have previous treatment with Herceptin® and taxane (separately or in combination)
This Medication is Not Approvable for the following condition(s).
Any condition not listed above as an approved indication.
Recommended dose: 3.6mg/kg IV every 3 weeks (21 day cycle) until disease progression or unacceptable toxicity
Duration of Therapy
Initial authorization: one year
Western Health Advantage Pharmacy and Therapeutics Committee
Approved/Revised: May 2013 | Reviewed: December 3, 2013