HERCEPTIN HYLECTA (trastuzumab and hyaluronidase-oysk)

HERCEPTIN HYLECTA (trastuzumab and hyaluronidase-oysk)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

• Indicated for adjuvant treatment of adults with HER2 overexpressing node positive or node negative breast cancer:
  • As part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
  • As part of a treatment regimen with docetaxel and carboplatin
  • As a single agent following multi-modality anthracycline based therapy

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

• Patient is 18 years of age or older, AND
• Medication is prescribed by or in consultation with an oncologist, AND
• Patient has a diagnosis of HER2 positive breast cancer as supported by chart note documentation, AND
• Patient meets one of the following:
  • Herceptin Hylecta™ is to be used for adjuvant treatment, OR
  • Herceptin Hylecta™ is used for metastatic disease

Dosing:

•  600 mg/10,000 units (600 mg trastuzumab and 10,000 units
  hyaluronidase) administered subcutaneously over approximately 2-5 minutes once every three weeks

Approval:

• 1 year