Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Eribulin mesylate (Halaven) may be considered medically necessary for ANY of the following conditions:
Breast Cancer
- Metastatic breast cancer in individuals who have previously received at least two (2) chemotherapeutic regimens for the treatment of metastatic disease including an anthracycline and a taxane in either the adjuvant or metastatic setting; or
Soft Tissue Sarcoma
- Unresectable or metastatic liposarcoma in individuals who have received a prior anthracycline-containing regimen; or
Compendia Sources
Eribulin mesylate (Halaven) may be considered medically necessary for treatment of any of the current category 1, 2A, or 2B NCCN recommendations.
The use of eribulin mesylate (Halaven) for all other indications not listed in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness cannot be established by the available published peer-reviewed literature.
Procedure Code
