Zytiga — Cigna
Metastatic castration-resistant prostate cancer
Preferred products
- generic abiraterone acetate tablets
Initial criteria
- Individual meets the standard Oncology – Abiraterone Acetate Prior Authorization Policy criteria; AND
- Individual has tried generic abiraterone acetate tablets; AND
- Individual cannot continue to use the Preferred medication due to a formulation difference in the inactive ingredient(s) (e.g., difference in dyes, fillers, preservatives) which, per the prescriber, would result in a significant allergy or serious adverse reaction. [documentation required]
Approval duration
1 year