RUBRACA (rucaparib)
SELF ADMINISTRATION - ORAL
Indications for Prior Authorization:
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for use as monotherapy for the treatment of patients with deleterious BRCA mutation (germline and/or somatic) associated advanced ovarian cancer who have been treated with two or more chemotherapies
Patients must meet the following criteria for the indication(s) above:
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Diagnosis of deleterious germline BRCA mutations confirmed by genetic testing
- Patient has prior history of treatment with at least 2 chemotherapy regimens
- Females of reproductive potential: pregnancy testing prior to treatment initiation and use of contraception during therapy and for 6 months after the last dose
- Continuation allowed until disease progression or unacceptable toxicity
The following conditions do not meet the criteria for use as established by WHA P&T committee:
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All non-FDA approved uses not listed in the approved indications
Dosing:
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600mg (two 300mg tablets) orally twice daily
Approval:
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Initial approval: 2 months
- Renewal: 6 months
Last review date: March 22, 2017