Subject: Specialty Quantity Limit Mekinist 1682-H P2022

Drug

MEKINIST  (trametinib)

Policy:

      I.  PROGRAM DESCRIPTION

           The standard limit is designed to allow a quantity sufficient for the most
           common uses of the medication. The recommended dosing parameters
           for the treatment of all FDA-approved indications fall within the
           standard limits. Coverage of an additional quantity may be reviewed on
           a case-by-case basis upon request.

 

    II.  COVERED QUANTITIES

Medication	Standard Limit	FDA-recommended dosing
Mekinist (trametinib)  0.5 mg tablet	90 tablets per 30 days	Standard: 2 mg once daily   First dose reduction: 1.5 mg once       daily   Second dose reduction: 1 mg once       daily
Mekinist (trametinib)  2 mg tablet	30 tablets per 30 days

           

Place of Service:

Outpatient

The above policy is based on the following references:

1. Mekinist [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; May 2021.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

April 16, 2022