BAVENCIO (avelumab)
OFFICE ADMINISTRATION [medical benefit]
Indications for Prior Authorization:
-
Treatment of adult and pediatric patients at least 12 years of age with metastatic Merkel cell carcinoma
Patients must meet the following criteria for the indication(s) above:
- Prescribed by an oncologist; AND
- Diagnosis of metastatic Merkel cell carcinoma; AND
- 12 years or older; AND
- Patient has tried and failed guideline recommended chemotherapy treatment regimen(s)
Dosing:
- 10 mg/kg IV infustion over 60 minutes once every 2 weeks
- Premedicate with an antihistamine and acetaminophen before the first four Bavencio infusions
- Dose modifications recommended based on adverse events
Approval:
- Initial: 3 months
- Renewal: 1 year
Last review date: June 12, 2017