Trodelvy (sacituzumab) is considered medically necessary for members meeting all
of the following criteria:
Diagnosis of metastatic
triple-negative breast cancer (mTNBC);
Member has received at
least two prior therapies for metastatic disease
Member is > 18
years of age
Initial authorization is for 6 months.
Reauthorization (12 months) is approved if documentation provided of tumor
response with disease stabilization or reduction of tumor size and spread.
Used In This BI:
No current specific HCPCS
Injection, sacituzumab govitecan-hziy, 2.5 mg