Nubeqa (darolutamide) — Highmark
metastatic castration-sensitive prostate cancer
Initial criteria
- age ≥ 18 years
- For CRPC: diagnosis of non-metastatic castration-resistant prostate cancer (ICD-10: C61, Z19.2) AND Nubeqa is being used in combination with a GnRH analog OR the member has had a bilateral orchiectomy
- For CSPC: diagnosis of metastatic castration-sensitive prostate cancer (ICD-10: C61, Z19.1) AND Nubeqa is being used in combination with a GnRH analog OR the member has had a bilateral orchiectomy
Reauthorization criteria
- Prescriber attests the member is tolerating therapy AND has experienced a therapeutic response defined as disease improvement OR delayed disease progression
Approval duration
up to 2 years