Abirtega™ (abiraterone acetate tablets – CivicaScript) — Cigna
Prostate Cancer – Post Radical Prostatectomy or Radiation Therapy
Initial criteria
- Patient age ≥ 18 years
- Medication is used in combination with prednisone
- Patient meets ONE of the following: (i) PSA persistence or recurrence following radical prostatectomy OR (ii) PSA recurrence or positive DRE after radiation therapy
- Patient has pelvic nodal recurrence or positive regional lymph nodes
- Patient meets ONE of the following: (i) Medication is concurrently used with a GnRH analog OR (ii) Patient has had a bilateral orchiectomy
Approval duration
1 year