INFINZI (durvalumab IV)
OFFICE ADMINISTRATION
Indications for Prior Authorization:
- Treatment of patients with locally advanced or metastatic urothelial carcinoma who:
- have disease progression during or following platium-containing chemotherapy
- have disease progression within 12 months of neoadjuvant or adjuvant treatment with platium-containing chemotherapy
Patients must meet the following criteria for the indication(s) above:
- Prescribed by an oncologist, AND
- 18 years or older, AND
- Confirmed diagnosis of advanced/metastatic urothelial carcinoma in patients who failed platium-containing chemotherapy or have disease progression within 12 months of neoadjuvant/adjuvant treatment with platium-containing chemotherapy, AND
- Patient is unable to take or has failed Keytruda
Dosing:
- 10 mg/kg IV infusion over 60 minutes every 2 weeks
Approval:
- Initial: 6 months
- Renewal: 1 year