WHA

Yonsa (abiraterone acetate) - PA, NF

Indications for Prior Authorization

Yonsa (abiraterone acetate)
  • For diagnosis of Metastatic Castration-Resistant Prostate Cancer (mCRPC)
    Indicated in combination with methylprednisolone for the treatment of patients with metastatic castration-resistant prostate cancer.

Criteria

Yonsa

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)
For diagnosis of Castration-Resistant Prostate Cancer (mCRPC)

  • Diagnosis of castration resistant (chemical or surgical) prostate cancer
    • AND
  • One of the following:
    • Trial and failure, contraindication, or intolerance to Xtandi (enzalutamide)
      • OR
    • For continuation of prior therapy
Yonsa

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Castration-Resistant Prostate Cancer (mCRPC)

  • Patient does not show evidence of progressive disease while on therapy
Yonsa

Non Formulary

Length of Approval: 12 Month(s)
For diagnosis of Castration-Resistant Prostate Cancer (mCRPC)

  • Diagnosis of castration resistant (chemical or surgical) prostate cancer
    • AND
  • One of the following:
    • Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to Xtandi (enzalutamide)
      • OR
    • Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy

  • Guideline ID
    GL-147048

  • Formulary
    EHB

  • Effective date
    Jul 1, 2024

  • P&T approval date
    Jul 18, 2018

P & T Revisions

2024-05-03, 2023-07-05, 2023-05-04, 2023-03-31, 2022-08-23, 2022-05-03, 2021-11-24, 2021-09-28, 2021-05-11, 2020-04-09, 2020-01-22

  1. Yonsa prescribing information. Sun Pharmaceutical Industries, Inc. Cranbury, NJ. July 2022.
  2. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Prostate Cancer v.3.2022. Available by subscription at: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed May 3, 2022.
  1. Most men with advanced disease eventually stop responding to traditional ADT and are categorized as castration-resistant (also known as castration-recurrent). [2]
  • 2024-05-03: Annual review: No criteria changes.
  • 2023-07-05: Removed specialist requirement
  • 2023-05-04: Annual review: Updated criteria, updated references and background.
  • 2023-03-31: Updated GPIs
  • 2022-08-23: Background update
  • 2022-05-03: Annual review: No criteria changes. Updated references.
  • 2021-11-24: Update to create non-formulary criteria within guideline.
  • 2021-09-28: Annual review: updated references
  • 2021-05-11: Annual review: updated references
  • 2020-04-09: Annual review: Updated background and references; removed reference to the product name in the reauthorization criteria (no change to clinical intent).
  • 2020-01-22: revised criteria