OGSIVEO (nirogacestat)

OGSIVEO (nirogacestat)

Self-Administration – oral

Diagnosis considered for coverage:

• DT: Indicated for adult patients with progressing desmoid tumors (DT) who require systemic treatment

Coverage Criteria:

For diagnosis of desmoid tumors (DT):

• Diagnosis of desmoid tumor; AND
• Disease is progressive; AND
• Patient requires systemic treatment

Reauthorization Criteria:

For diagnosis of desmoid tumors (DT):

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

Dosing:

DT:

• 150 mg administered orally twice daily until disease progression or unacceptable toxicity 

Coverage Duration: 

• Initial: 1 year
• Reauthorization: 1 year 

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information: 

• Each 150 mg dose of Ogsiveo consists of three 50 mg tablets

Policy Updates:

• Effective 6/1/2024 – New policy approved by WHA P&T Committee. (P&T, 5/21/2024)

References:

1. Ogsiveo Prescribing Information. SpringWorks Therapeutics, Inc. Stamford, CT. December 2023.