Palbociclib (Ibrance)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Treatment of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer in combination with:
    • an aromatase inhibitor as initial endocrine based therapy in postmenopausal women; or
    • fulvestrant in women with disease progression following endocrine therapy

Patients must meet the following criteria for the indications above:

  • Prescribed by an oncologist, AND
  • Patient is at least 18 years of age, AND
  • Medical record documentation confirms diagnosis of HR-positive AND HER2-negative advanced or metastatic breast cancer, AND
  • Medical record documentation confirms the patient is to be on an aromatase inhibitor as initial endocrine-based therapy OR fulvestrat in women with disease progression following endrocrine therapy

Dosing:

  • Recommended starting dose: 125 mg once daily with food for 21 days followed by 7 days off treatment
  • Dosing interruption and/or dose reductions are recommended based on individual safety and tolerability
  • Taken with an aromatase inhibitor or fulvestrant

Approval:

  • First time approval: 6 months
  • Continuation: 1 year