SELF ADMINISTRATION - ORAL
Indications for Prior Authorization:
- 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.
The following criteria must be met:
- Medication is prescribed by or in consultation with an oncologist, AND
- Patient has unresectable, advanced, or metastatic melanoma, AND
- Patient has melanoma with BRAF V600 mutation, AND
- Mektovi will be used in combination with Braftovi™ (encorafenib capsules)
- 45 mg orally taken twice daily in combination with encorafenib until disease progression or unacceptable toxicity.
Last review date: August 27, 2019