Zejula — CareFirst (Caremark)

Initial criteria

• Diagnosis of metastatic castration-resistant prostate cancer
• Disease has BRCA1 or BRCA2 mutation
• Member has had a bilateral orchiectomy OR will be using the requested medication in combination with a luteinizing hormone-releasing hormone (LHRH) agonist (e.g., goserelin, leuprolide) or antagonist (e.g., degarelix, relugolix)
• Requested medication will be used in combination with abiraterone and concurrent steroids (prednisone or methylprednisolone)

Reauthorization criteria

• No evidence of unacceptable toxicity or disease progression while on the current regimen

Approval duration

12 months