Approved for: office administration
Indications for Prior Authorization
- refractory metastatic breast cancer
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
All of the following must be met:
- 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 recommended dose is up to 1.4 mg/m2 IV on days one and eight of a 21 day cycle.
The drug is approvable for coverage for one year.
M:\Guidelines\WHA Injectable\eribulin (Halaven) 2011.doc
Western Health Advantage Pharmacy and Therapeutics Committee
Approved/Revised: May 2011 Reviewed: December 2013