Avelumab (Bavencio)

OFFICE ADMINISTRATION [medical benefit]

Indications for Prior Authorization:

  • Treatment of adult and pediatric patients at least 12 years of age with metastatic Merkel cell carcinoma

Patients must meet the following criteria for the indication(s) above:

  • Prescribed by an oncologist; AND
  • Diagnosis of metastatic Merkel cell carcinoma; AND
  • 12 years or older; AND
  • Patient has tried and failed guideline recommended chemotherapy treatment regimen(s)

Dosing:

  • 10 mg/kg IV infustion over 60 minutes once every 2 weeks
  • Premedicate with an antihistamine and acetaminophen before the first four Bavencio infusions
  • Dose modifications recommended based on adverse events

Approval:

  • Initial: 3 months
  • Renewal: 1 year

Last review date: June 12, 2017