Pharmacy Prior Authorization Criteria

Truqap (capivasertib)

Indications for Prior Authorization

Truqap (capivasertib)

• For diagnosis of Breast Cancer
  Indicated, in combination with fulvestrant for the treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN-alterations as detected by an FDA-approved test following progression on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy.

Criteria

Truqap

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

• Diagnosis of breast cancer
AND
• Disease is one of the following:
• Locally advanced
• Metastatic
AND
• Will be taken in combination with fulvestrant
AND
• Disease is hormone receptor (HR)-positive
AND
• Disease is human epidermal growth factor receptor 2 (HER2)-negative
AND
• Patient has one or more PIK3CA/AKT1/PTEN-alterations as detected by a U.S. Food and Drug Administration (FDA)-approved test or a test performed at a facility approved by Clinical Laboratory Improvement Amendments (CLIA)
AND
• One of the following:
• Following progression on at least one endocrine-based regimen in the metastatic setting (e.g., anastrozole, letrozole, exemestane, tamoxifen, etc).
OR
• Recurrence on or within 12 months of completing adjuvant therapy (e.g., chemotherapy)

Truqap

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

• Patient does not show evidence of progressive disease while on therapy

P & T Revisions

2024-11-26, 2024-01-18, 2024-01-03

References

1. Truqap Prescribing Information. AstraZeneca Pharmaceuticals LP. Wilmington, DE. November 2023.

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Revision History

• 2024-11-26: Added new 160mg and 200mg therapy packs to guideline
• 2024-01-18: Removed OptumRx SP formulary and added OptumRx formulary instead
• 2024-01-03: New Program for Truqap

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