Rucaparib (Rubraca)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • for use as monotherapy for the treatment of patients with deleterious BRCA mutation (germline and/or somatic) associated advanced ovarian cancer who have been treated with two or more chemotherapies

Patients must meet the following criteria for the indication(s) above:

  • Diagnosis of deleterious germline BRCA mutations confirmed by genetic testing

  • Patient has prior history of treatment with at least 2 chemotherapy regimens
  • Females of reproductive potential: pregnancy testing prior to treatment initiation and use of contraception during therapy and for 6 months after the last dose
  • Continuation allowed until disease progression or unacceptable toxicity

The following conditions do not meet the criteria for use as established by WHA P&T committee:

  • All non-FDA approved uses not listed in the approved indications

Dosing:

  • 600mg (two 300mg tablets) orally twice daily

Approval:

  • Initial approval: 2 months

  • Renewal: 6 months

 

Last review date: March 22, 2017

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