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:
- Ogsiveo Prescribing Information. SpringWorks Therapeutics, Inc. Stamford, CT. December 2023.
Last review date: June 1, 2024