pembrolizumab (Keytruda®)


Indications for Prior Authorization:

  • Patients with unresectable or metastatic melanoma with disease progression following ipilimumab (Yervoy) therapy

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

  • If BRAF V600 positive, patients must first fail a BRAF inhibitor

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

  • Diagnosis by oncologist
  • BRAF status determination


  • The recommended dose is 2 mg/Kg by intravenous infusion over 30 minutes every 3 weeks


Last review date: December 1, 2014

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