Subject: Specialty Quantity Limit Truqap 6253-H P2024

Drug

TRUQAP  (capivasertib)

Policy:

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.

Covered Quantities

Medication	Standard Limit
Truqap (capivasertib) 160 mg tablet	64 tablets per 28 days
Truqap (capivasertib) 200 mg tablet	64 tablets per 28 days

FDA-recommended Dosing

The recommended dose of Truqap is 400 mg twice daily for 4 days followed by 3 days off.

First dose reduction: 320 mg twice daily for 4 days followed by 3 days off

Second dose reduction: 200 mg twice daily for 4 days followed by 3 days off

Dose modifications are recommended for adverse reactions and concomitant use with strong or moderate CYP3A inhibitors.

Place of Service:

Outpatient

The above policy is based on the following references:

1. Truqap [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; September 2024.

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.

June 07, 2025