COSELA (trilaciclib)

COSELA (trilaciclib)

Medical Administration – intravenous

Diagnosis considered for coverage:

• Indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for extensive-stage small cell lung cancer (ES-SCLC)

Coverage Criteria:

For diagnosis of Chemotherapy-Induced Myelosuppression in Adult Patients:

• Dose does not exceed 240 mg/m² per dose, AND
• Patient is 18 years of age or older, AND
• Diagnosis of extensive-stage small cell lung cancer (ES-SCLC), AND
• Prescribed by or in consultation with a hematologist/oncologist, AND
• Patient is receiving one of the following anti-cancer chemotherapeutic regimens:
  • Platinum/etoposide-containing regimen
  • Topotecan-containing regimen, AND
• Infusion is completed within 4 hours prior to the start of chemotherapy, AND
• The interval between doses on sequential days will not be greater than 28 hours

Coverage Duration:

• 6 months

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Policy Updates:

• 6/15/2021 – New policy approved by P&T.

References:

• Cosela Prescribing Information. G1 Therapeutics, Inc. Durham, NC. February 2021.