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
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
References
- Yonsa prescribing information. Sun Pharmaceutical Industries, Inc. Cranbury, NJ. July 2022.
- 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.
End Notes
- Most men with advanced disease eventually stop responding to traditional ADT and are categorized as castration-resistant (also known as castration-recurrent). [2]
Revision History
- 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
HEALTHY LIVING