Pharmacy Prior Authorization Criteria

Erleada (apalutamide)

Indications for Prior Authorization

Erleada (apalutamide)

• For diagnosis of Non-metastatic castration-resistant prostate cancer
  Indicated for the treatment of patients with non-metastatic, castration-resistant prostate cancer (NM-CRPC).

Erleada (apalutamide)

• For diagnosis of Metastatic castration-sensitive prostate cancer
  Indicated for the treatment of patients with metastatic, castration-sensitive prostate cancer (M-CSPC).

Criteria

Erleada

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

• Diagnosis of prostate cancer

Erleada

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

• Patient does not show evidence of disease progression while on therapy

P & T Revisions

2024-05-20, 2023-07-05, 2023-05-04, 2023-04-07, 2022-04-07, 2021-11-01, 2021-04-08, 2020-04-28, 2020-01-27, 2019-10-28

References

1. Erleada prescribing information. Janssen Ortho LLC. Gurabo, PR. December 2023.

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Revision History

• 2024-05-20: 2024 UM Annual Review. Combined CRPC and CSPC into one criteria bucket and updated criteria to just require diagnosis of prostate cancer. Background updates.
• 2023-07-05: Removed specialist requirement
• 2023-05-04: Updated criteria and background.
• 2023-04-07: Annual review: No criteria changes. Added new Erleada 240 mg tablet formulation to existing criteria sets. Updated references.
• 2022-04-07: Annual review: No criteria changes. Updated references.
• 2021-11-01: Remove trial and failure requirement through Xtandi or Nubeqa due to formulary strategy.
• 2021-04-08: annual review: updated references
• 2020-04-28: Annual Review: no criteria changes
• 2020-01-27: revised criteria
• 2019-10-28: Updated guideline with new indication

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