Subject: Specialty Quantity Limit Truqap 6253-H P2025a

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 tablets	64 tablets per 28 days
Truqap (capivasertib) 160 mg carton (4 blister packs with 16 tablets each)	1 carton (64 tablets) per 28 days
Truqap (capivasertib) 200 mg tablets	64 tablets per 28 days
Truqap (capivasertib) 200 mg carton (4 blister packs with 8 tablets each)	1 carton (32 tablets) per 28 days
Truqap (capivasertib) 200 mg carton (4 blister packs with 16 tablets each)	1 carton (64 tablets) per 28 days

FDA-recommended Dosing

400 mg twice daily for 4 days followed by 3 days off.

Dosage modifications are recommended for adverse reactions:

·        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

Dosage modification for concomitant use with strong or moderate CYP3A inhibitors:

·        320 mg twice daily for 4 days followed by 3 days off

Place of Service:

Outpatient

The above policy is based on the following references:

1. Truqap [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; June 20

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.

August 20, 2026