Cotellic

Drug - Cotellic® (cobimetinib fumarate) [Genentech, Inc.]

May 2016

Therapeutic area - Oncology

Approval criteria

• Patient must be 18 years of age or older AND
• Patient must be diagnosed with unresectable or metastatic melanoma AND
• Have a BRAF (BRAF) V600E or V600K mutation as detected by a BRAF V600 Mutation Test. Results of the BRAF mutation test must be submitted at time of request AND
• Must be prescribed in combination with vemurafenib

Quantity limit

Maximum of 63 tablets per 28 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411