Eribulin (Halaven)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

  • Refractory metastatic breast cancer

All of the following must be met as a condition(s) for coverage:

  • Single drug therapy for the treatment of metastatic breast cancer
  • Previous therapy with two National Comprehensive Cancer Network (NCCN) recommend chemotherapeutic regimens for the treatment of metastatic disease
  • Patient has had therapy or has a contraindication to therapy with and anthracycline and a taxane

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

  • Any other diagnosis not listed in the approved indications

Dosing:

  • The recommended dose is up to 1.4 mg/m2 IV on days one and eight of a 21 day cycle

Approval:

One year


 

Last review date: December 2, 2013

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