Zejula
Drug - Zejula® (niraparib) [Tesaro]
January 2018
Therapeutic Area - Oral Oncology
Initial approval criteria
- Patient is at least 18 years old AND
- Patient is diagnosed with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer AND
- Zejula will be used as monotherapy AND
- Therapy to begin no later than 8 weeks after the most recent platinum-containing regimen AND
- Must have had complete or partial response to platinum-based chemotherapy AND
- Prescriber must attest that female patients of reproductive potential will receive reproductive health counseling during treatment with Zejula and for at least 6 months following the last dose
- Initial approval is for 6 months
Renewal approval criteria
- Patient continues to meet initial review criteria AND
- Patient demonstrates no disease progression AND
- Absence of unacceptable toxicity (e.g. thrombocytopenia, anemia, neutropenia, hypertension, nausea, vomiting, abdominal pain/distention, dyspnea, fatigue/asthenia)
- Renewal approval is for 12 months
Quantity limits
102 tablets per 34 days
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411