Eribulin Mesylate (Halaven®)

Before September 30, 2026: Billing and clinical teams must implement prior authorization workflow for Eribulin Mesylate (Halaven®) claims. (1) Update billing system to require prior authorization for all Halaven claims for breast cancer and soft tissue sarcoma indications. (2) Establish intake checklist requiring HER2 status testing results documentation before prior auth submission for breast cancer cases. (3) Configure system to grant maximum 12-month authorization periods for initial approval and reauthorization when no unacceptable toxicity or disease progression is documented. (4) Train clinical staff to verify dosing compliance (1.4mg/m² on days 1 and 8 of 21-day cycle) and ensure treatment aligns with coverage criteria: single-agent HER2-negative therapy OR combination with margetuximab-cmkb/trastuzumab for HER2-positive as 4th-line+ for breast cancer. (5) For soft tissue sarcoma, ensure only covered histologies (retroperitoneal/intra-abdominal, pleomorphic rhabdomyosarcoma, extremity/body wall, head/neck, dedifferentiated liposarcoma, epithelioid hemangioendothelioma) are approved. Claims submitted without prior authorization or missing HER2 documentation will be denied.