Orgovyx (relugolix) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of advanced prostate cancer (ICD-10: C61)
• member is appropriate to receive androgen deprivation therapy (ADT) by meeting one (1) of the following: biochemical (prostate specific antigen [PSA]) or clinical relapse following local primary intervention; newly diagnosed castration-sensitive metastatic disease; advanced localized disease

Reauthorization criteria

• prescriber attests that the member is tolerating therapy
• member has experienced a therapeutic response defined as one (1) of the following: disease improvement OR delayed disease progression

Approval duration

12 months